Community Health Needs Assessment & Implementation Plan Summaries

Community Health Needs Assessment & Implementation Plan Summaries 2012

1 Community Health Needs Assessment and Implementation Strategy Summaries Saint Francis Memorial Hospital has been meeting the health needs of San Francisco for over 100 years. Founded in 1905 by a group of 5 physicians, Saint Francis Memorial Hospital continues to carry out its mission: dedicate our resources to: delivering compassionate, high-quality, affordable health services for our sisters and brothers who are poor and disenfranchised; and partnering with others in the community to improve the quality of life. Today, Saint Francis Memorial Hospital remains a thriving center of healing and innovation in medicine as well as a spiritual anchor to its community. Saint Francis Memorial Hospital maintains 253 licensed beds, located atop of San Francisco s legendary Nob Hill; it is a member of Dignity Health. About 65 percent of the patients are residents of San Francisco, while another 9 percent live in the greater Bay Area. The hospital also has a number of specialized programs that draw patients from all over Northern California and beyond. This report summarizes the plans for Saint Francis Memorial Hospital to sustain and develop new community benefit programs that: 1) address prioritized needs from the 2012 Community Health Needs Assessment (CHNA) conducted in collaboration with the San Francisco Department of Public Health (SFDPH), local nonprofit hospitals and academic partners and more than 500 community residents, and 2) respond to other identified community health needs.

2 Table of Contents I. 2012 Saint Francis Memorial Hospital Health Needs Assessment Summary: An assessment of the City and County of San Francisco conducted jointly by Saint Francis Memorial Hospital, the San Francisco Department of Public Health Department, local nonprofit hospitals and academic partners and more than 500 community residents. Attachments: A. Vision and Values Graphic for Community Health Improvement Planning in San Francisco B. SF Vision Illustration 08.28.12 C. Community Health Needs Assessment Timeline 01.17.13 D. Community Health Status Assessment: City and County of San Francisco_July 2012 E. Community Health Status Assessment Variables_March2012 F. Community Health Needs Assessment Data Synthesis Grid G. San Francisco Community Health Assessment and Profile_Sept. 2012 H. Health Care Services Master Plan (HCSMP): Health Care Facilities and Transit in San Francisco Asset Map I. Community Health Improvement Process Prioritization Event Presentation 08.03.12 J. Health Prioritization Score Sheet 08.03.12 K. Health Prioritization Worksheet 08.03.12 L. SF CHIP Timeline M. Criteria for Prioritizing Key Health Issues N. Community Health Improvement Planning: Strategies to Address Key Health Disparities Presentation 08.28.12 O. Community Health Improvement Planning: Strategies Vision Illustration P. Community Health Improvement Planning: Strategies Workshop Minutes - Safe and Healthy Living Environments 08.28.12 Q. Ensure Safe and Healthy Living Environments Handout R. Community Health Improvement Planning: Strategies Workshop Minutes - Healthy Eating and Physical Activity 08.28.12 S. Increase Healthy Eating and Physical Activity Handout T. Community Health Improvement Planning: Strategies Workshop Minutes - Access to High Quality Health Care and Services 08.28.12 U. Increase Access to High Quality Health Care and Services Handout II. Saint Francis Memorial Hospital Implementation Strategy and Community Benefit Plan Summary Attachments: V. San Francisco Community Health Improvement Plan_Dec. 2012 W. Leadership Council List

3 2012 Saint Francis Memorial Hospital Community Health Needs Assessment Summary: An assessment of City and County of San Francisco conducted jointly by Saint Francis Memorial Hospital, the San Francisco Department of Public Health Department, local nonprofit hospitals and academic partners, and more than 500 community residents. During 2012, a community health needs assessment (CHNA) was conducted by Saint Francis Memorial Hospital, the San Francisco Department of Public Health, local nonprofit hospitals and academic partners and more than 500 community residents for the 805,235 residents of City and County of San Francisco, California. Building on the success of Community Vital Signs, San Francisco s past community health assessment effort conducted in 2010, Saint Francis Memorial Hospital relied on the Mobilizing for Action through Planning and Partnerships (MAPP) framework to guide the current CHNA. The result was a community-driven process that engaged more than 500 community residents, the local health department and nonprofit hospitals and academic partners and embraced the following values: To facilitate alignment of San Francisco s priorities, resources, and actions to improve health and well-being. To ensure that health equity is addressed throughout program planning and service delivery. To promote community connections that support health and well-being. Description of Community Served by the Hospitals Located in northern California, San Francisco is a seven by seven square mile coastal, metropolitan city and county that includes Treasure Island and Yerba Buena Island, just northeast of the mainland. The only consolidated city and county in the state, San Francisco is densely populated and boasts culturally diverse neighborhoods in which residents speak more than 12 different languages. According to the 2010 Decennial Census, San Francisco has a population of 805,235 residents and experienced mild population growth of nearly four percent between 2000 and 2010. Although San Francisco was once considered home to a relatively young population, the City and County has experienced a decrease among children and families with young children. In addition, over the next two decades, it is estimated that 55 percent of the population will be over the age of 45, and the population over age 75 will increase from 7 to 11 percent. San Francisco s population will continue to change given that there are more people moving out of the City and County than are moving in. Although the median household income in San Francisco seems relatively high at $70,040, San Francisco has the largest income inequality of the 9 Bay Area counties. Income inequality is directly related to health inequality, with higher income linked to better health: the greater the gap between the richest and poorest people, the greater the differences in health. Data and a map detailing current demographics, including income levels, age, race/ethnicity, and educational attainment for the City and County of San Francisco is included in Attachment G. Who was Involved in the Assessment In January 2012, Saint Francis Memorial Hospital became aware of a number of other community-based needs assessments that were in progress throughout the city. In order to reduce duplication of effort, leverage resources and to respect

community members time, the hospital aligned its community health needs assessment process with SFDPH s community health assessment (CHA) and improvement processes. The alignment brought together representatives from San Francisco neighborhoods, health care institutions, government agencies, community groups and service providers. Specifically, hospital and academic partners joined SFDPH to form the CHA/CHIP Leadership Council, which supported the CHA and guided the development and implementation of San Francisco s Community Health Improvement Plan. The Leadership Council is committed to transparency and community and partner engagement throughout the community health improvement process. Community residents from each of San Francisco s 21 neighborhood areas came together for a day-long event to discuss their views of health and their hopes for San Francisco s health future. This resulted in elements of a community-guided health vision for the City and County of San Francisco. SFDPH convened a 42-member Task Force to support San Francisco s CHA and a parallel effort, the Health Care Services Master Plan (HCSMP). Task Force members represented a range of community stakeholders such as hospitals/clinics, K-12 education, small business, urban planning, consumer groups, nonprofits representing different ethnic minority groups, and more. To ensure community participation in the HCSMP and CHA processes, the Task Force met a total of 10 times between July 2011 and May 2012 four of those in different San Francisco neighborhoods and engaged more than 100 community residents in dialogue to better determine how to improve the health of all San Franciscans with a particular focus on the City and County s most vulnerable populations. To encourage community dialogue, Task Force neighborhood meetings took place in the evening, and SFDPH provided interpretation services in Spanish and Cantonese. San Francisco engaged 224 community residents in focus groups and interviewed 40 community stakeholders to learn more about San Franciscans definitions of health and wellness as well as perceptions of San Francisco s strengths versus areas for health improvement. Focus groups targeted San Francisco subpopulations (seniors and persons with disabilities, transgendered people, monolingual Spanish speakers, and teens) and specific neighborhoods (Bayview- Hunters Point, Chinatown, Excelsior, Mission, Sunset/Richmond, and Tenderloin). Focus group participants greatly informed San Francisco s health vision as well as the Community Themes and Strengths Assessment. A 10-member data advisory committee comprised of local public health system partners, residents, and SFDPH staff oversaw the collection of data indicators for the Community Health Status Assessment (CHSA). This body also ensured the integrity of the CHSA s methodology and qualitative data. A number of consulting firms were also involved throughout the health assessment process, including 1) Heart Beets for community engagement; 2) Circle Point for ongoing communication with stakeholders; 3) Harder and Company for data collection and analysis; 4) Nancy Shemick, MPA for meeting facilitation and report writing. 4 How the Assessment was Conducted As elements of the assessment, from July to April 2012, the Health Care Services Master Plan Task Force met in a series of 9 meetings, including neighborhoodbased community forums. The data consulting firm, Harder and Company Associates, conducted focus groups to learn more about their perspective on community health needs. These focus groups targeted San Francisco subpopulations (seniors and persons with disabilities, transgendered people, monolingual Spanish speakers, and teens). Findings were summarized in the Community Health Status Assessment (CHSA), which was completed in July

2012. The CHSA provides data for more than 150 indicators over ten broad based categories and can be found at: http://www.sfdph.org/dph/files/chip/communityhealthstatusassessment.pdf As part of the Public Health Department s Population Health and Prevention Integration, focus groups targeting specific neighborhoods were conducted from March to May 2012. These focus groups consisted of residents from Bayview- Hunters Point, Chinatown, Excelsior, Mission Sunset/Richmond and Tenderloin, neighborhoods that that were likely to experience health disparities. A visioning process was completed with grassroots community participants representing 21 neighborhoods to develop a community-informed health and wellness vision for San Francisco. In each of these sessions, participants answered questions like, What does health and well-being mean to you? A final visioning session took place on June 13, 2012. In May 2012, the four MAPP assessments and the data gathered from the San Francisco s last community health assessment and improvement effort in 2010 (also known as Community Vital Signs), were documented by SFDPH in a grid format to organize outcomes and common themes. Synthesizing and combining MAPP and Community Vital Signs data yielded a more aligned community health approach tailored to San Francisco. The graphic below depicts how various processes were aligned: 5 The analysis grid was then reviewed by selected members of the CHA/CHIP Leadership Council, San Francisco s Mayor s Office, and SFDPH leadership. The data analysis yielded 7 cross cutting themes listed below: 1. Ensure safe and healthy living environments 2. Improve behavioral health 3. Increase access to quality health care and services 4. Increase physical activity and healthy eating 5. Reduce the spread of infectious disease 6. Support early childhood development 7. Support seniors and persons with disabilities

The prioritization process identified 3 priority issues for the community: On August 3, 2012, SFDPH and its nonprofit hospital and academic partners convened nearly 30 stakeholders for a half-day session to identify communitydriven, data-based health priorities for action in San Francisco. Participants included representatives from SFDPH, San Francisco s nonprofit hospitals and other members of the Community Benefit Partnership, the University of California San Francisco, and the San Francisco Human Services Agency. Following a brief presentation of San Francisco s CHA efforts and resulting data and cross-cutting themes, session participants selected San Francisco s 3 health priorities as follows: 1. Participants reviewed a set of five standard criteria developed and vetted by San Francisco s CHA/CHIP Leadership Council. Inspired by the Hanlon Method, San Francisco priority-selection criteria include: Magnitude/Size of the Public Health Issue Other Factors Related to Importance of the Public Health Issue Effectiveness of Interventions Feasibility and Sustainability of Intervention Implementation Equity (Please note that San Francisco elected to highlight equity as a priority-selection criterion to uphold the city/county s fundamental value of reducing disparities in health access and outcomes for San Francisco s diverse communities. 2. Each participant individually ranked the seven identified cross-cutting data themes against health priority-selection criteria with 1 indicating highest rank and 7 indicating lowest rank. 3. Facilitators totaled individual scores for each data theme and criterion to identify San Francisco s top 3 health priorities for action. These priorities include: Ensure safe and healthy living environments Increase physical activity and healthy eating Increase access to quality health care and services 4. Session participants reviewed the identified priorities and agreed that all selected priority issues were reasonable and appropriate for San Francisco. The full assessment summary, San Francisco Department of Public Health s San Francisco Community Health Assessment + Profile can be found online at www.sfdph.org. 6 Community Assets Identified Effective January 2, 2011, San Francisco Ordinance No. 300-10 requires the creation of a Health Care Services Master Plan (HCSMP) which identifies the current and projected needs for and locations of health care services within San Francisco. These needs are available as maps at: http://www.sfdph.org/dph/files/hcsmp/hcsmpmapfor_09222011.pdf In addition to the acute not-for-profit community hospitals, a university hospital that serves as a tertiary care center and the Department of Public Health which operates an acute and a long term hospital along with many community clinics, there are numerous community agencies that provide direct service, education and/or advocacy. A unique asset for San Francisco is Healthy San Francisco, a universal healthcare program created by the City of San Francisco that makes health care services accessible and affordable for uninsured residents. The program offers a new way for San Francisco residents who do not have health insurance to have basic and ongoing medical care. It is available to all San Francisco residents regardless of immigration status, employment status, or pre-existing medical conditions. San Francisco residents with an income at or below 500% of the Federal Poverty Level (for one person $55,860; for a family of four $135,060) are eligible to enroll in this one-of-kind access program. Below is a list of the 2012 assessment s priorities with some available community

7 assets and resources identified to respond to each need: Priority 1: Ensure Safe and Healthy Living Environment Strong interagency and community collaboration (e.g., SFHIP, CBP, Community Transformation Grant Team, Healthy Homes Project) Sustainable Communities Index, which facilitates health impact assessment in land use planning Strong existing programs that address these issues such as SF Tobacco Free Project and Bayview Safe Haven after school program (Effective Practice) Strong network of existing and well-maintained parks Priority 2: Increase Healthy Eating and Physical Activity Strong interagency and community collaboration to improve nutrition (e.g., SFHIP, Southeast Food Access Network, SF Food Security Task Force) Strong interagency and community collaboration to improve opportunities for physical activity (e.g., Sunday Streets, Walk First, Bayview HEAL Zone, Safe Routes to School, SFHIP) Current Assessment Efforts: Communities of Excellence in Nutrition, Physical Activity, and Obesity Prevention (CX3) Priority 3: Increase Access to Quality Health Care and Services Health Reform as driver toward primary care home as well as integration and Coordination Healthy San Francisco + SFPATH SF system of care (SFDPH, nonprofit hospitals, community clinics, private providers) Summaries: Assessments and Priorities Ensure Safe and Healthy Living Environments Despite being one of the wealthiest and most socially progressive cities in the country, not everyone in San Francisco has a safe and healthy place to live. Some neighborhoods in San Francisco, for example, have great access to parks, public transit, grocery stores, and other resources that benefit health and wellness. Other neighborhoods often poor communities of color are closer to fast food and alcohol outlets, freeways, industrial pollutants, and other factors that contribute to high rates of disease, death, injury, and violence. Community residents echoed the above in focus groups, community meetings throughout San Francisco s CHA, and also as voiced through formal grievance channels such as through SFDPH s Environmental Health Section. Bayview-Hunters Point residents, for example, voiced concerns about environmental hazards in their neighborhood and emphasized along with other communities the need for access to clean, green open spaces to support their health and wellbeing. Community data also indicate that certain neighborhoods and particular racial/ethnic groups are more impacted by crime and violence. San Francisco has an annual violent crime rate of 824 per 100,000, which is higher than both the state average (500 per 100,000) and the national benchmark (73 per 100,000). Looking at homicides alone, San Francisco experienced a decline in the number of homicides between 2007 and 2009; however, Black/African American residents, followed by Latinos, are more likely than other racial/ethnic groups to be killed prematurely by homicide. The Ensure Safe and Healthy Living Environments priority highlights the need for health and wellness-oriented land use planning, meaningful opportunities for

outdoor recreation, and a positive built environment for the health of all individuals and communities. Science links health conditions such as heart disease, diabetes, and cancer to daily practices like eating a healthy, balanced diet and getting regular exercise. However, the healthy choice is not always the easy choice particularly for San Francisco s more vulnerable residents as was repeatedly voiced by community members throughout the CHA/CHIP development process. Socioeconomic factors such as whether people can afford to buy nutritious foods and safely engage in exercise in their neighborhoods and environmental factors such as whether healthy food options are locally available impact what individuals eat as well as their activity practices. Increase Healthy Eating and Physical Activity San Franciscans of all ages fall short of the California average in terms of consumption of five or more fruits and vegetables daily. In addition, disparities exist among different racial/ethnic groups in terms of obesity risk; Latino adults are at greatest risk for obesity, followed by Black/African American residents. Physical activity can be discouraged by risk for injury. In San Francisco, for example, pedestrians face greater risk for injury and death in some neighborhoods than others. The Financial District, Chinatown, South of Market, Downtown/Civic Center, North Beach, Castro/Upper Market, Western Addition, Glen Park, and Mission neighborhoods exceed the citywide average for pedestrian injury and death. The Increase Healthy Eating and Physical Activity priority strives to demonstrate the link between diet, inactivity, and chronic disease and to help San Francisco create environments that make healthy choices the easy choices, so all San Francisco residents have an equal chance to eat well and move more. Increase Access to High Quality Health Care and Services Access to comprehensive, high quality health care and other services is essential in preventing illness, promoting wellness, and fostering vibrant communities. While San Francisco often outperforms the state and other California counties in terms of health care resources like primary care doctors, availability does not always equal accessibility; many of San Francisco s more vulnerable residents ranging from low-income persons to non-native English speakers seeking culturally competent care in their primary language struggle to get the services they need to be healthy and well. As of 2010, 94 percent of San Franciscans between the ages of 18 and 64 either had health insurance or were enrolled in Healthy San Francisco, a program that is part of San Francisco s safety net. San Francisco, however, falls short of the Healthy People 2020 target for residents with a usual source of care. Some residents may lack a usual source of care because they do not have insurance and are not enrolled in Healthy San Francisco; others, because providers do not accept their coverage. According to a study conducted in 2008, California providers are less likely to serve Medi-Cal beneficiaries compared to those with private insurance or Medicare, likely because of the state s low reimbursement rate. Data also suggest that San Franciscans who speak English less than very well as well as English speakers with limited literacy skills may struggle to access the services they need. In focus groups, residents often expressed the importance of the linguistic and cultural competency of service providers in diminishing their anxiety and frustration. The Increase Access to High Quality Health Care and Services priority strives to bridge these gaps. 8

Next Steps In coordination with nonprofit hospital and academic partners as well as the broader San Francisco community, the San Francisco Department of Public Health (SFDPH) built on the success of the 14-month community health assessment (CHA) effort to create a community health improvement plan (CHIP) for San Francisco. 9 SFDPH and its partners endeavored to create a community-driven and transparent CHIP aligned with community values. The result was a community-driven CHIP development process that engaged more than 160 community residents and local public health system partners to identify key health priorities for action. These partners included: Hospital and academic partners, who continued to partner with SFDPH on San Francisco s CHA/CHIP Leadership Council, which has guided the assessment development and the implementation of San Francisco s health improvement plan. Nearly 30 community stakeholders including representatives from San Francisco s nonprofit hospitals, academic institutions, health plans, the African American Health Disparities Project, San Francisco Human Services Agency, and SFDPH. Close to 70 community residents and members of the local public health system including representatives from K-12 education, higher education, philanthropy, nonprofit agencies, minority health equity coalitions, government (including the San Francisco Mayor s Office and Health Commission), hospitals, and more. More than 60 health content experts engaged with SFDPH as well as its hospital and academic partners to refine priority goals, objectives, measures, and strategies that have come to form the current CHIP. SFDPH and its partners developed goals and objectives for each priority as well as related measures and strategies that comprise the current CHIP. The diversity of project leads assigned to identified strategies including a range of government agencies, public/nonprofit/community collaborations, nonprofit organizations, and other entities demonstrates that the current CHIP is a bold effort to harness the collective impact of San Francisco s communities and local public health system partners to improve population health. Slated to begin implementation in early 2013, SFDPH and its partners plan to conduct a CHA/CHIP process every 3 years in alignment with other health improvement initiatives. Utilizing the City and County s Community Health Assessment, Saint Francis Memorial Hospital s Community Advisory Committee will meet to review and discuss the hospital s existing community benefit activities and assets in regard to each priority, and identify opportunities for collaboration in order to enhance impact and avoid unnecessary duplication of services. The next phase will include developing an implementation strategy for each health need identified and build on assets and resources. The implementation plan will incorporate evidence-based strategies wherever possible and take into account Dignity Health goals and metrics, as well as Saint Francis Memorial Hospital s Strategic Plan. This assessment summary is on the website of Dignity Health. A copy can also be obtained by contacting Saint Francis Memorial Hospital s Community Services office.

Saint Francis Memorial Hospital Implementation Strategy For FY2012-2014 Summary 10 10 Saint Francis Memorial Hospital has been meeting the health needs of San Francisco for over 100 years. Founded in 1905 by a group of five physicians, Saint Francis Memorial Hospital continues to carry out its mission: dedicate our resources to: delivering compassionate, high-quality, affordable health services for our sisters and brothers who are poor and disenfranchised; and partnering with others in the community to improve the quality of life. Today, Saint Francis Memorial Hospital remains a thriving center of healing and innovation in medicine as well as a spiritual anchor to its community. Saint Francis Memorial Hospital maintains 253 licensed beds, located atop of San Francisco s legendary Nob Hill; it is a member of Dignity Health. About 65 percent of the patients are residents of San Francisco, while another 9 percent live in the greater Bay Area. The hospital also has a number of specialized programs that draw patients from all over Northern California and beyond. This report summarizes the plans for Saint Francis Memorial Hospital to sustain and develop new community benefit programs that: 1) address prioritized needs from the 2012 Community Health Needs Assessment (CHNA) conducted in collaboration with the San Francisco Department of Public Health (SFDPH), local nonprofit hospitals and academic partners and more than 500 community residents, and 2) respond to other identified community health needs. Target Areas and Populations How the Implementation Strategy Was Developed Using the 2010 Decennial Census, the City and County of San Francisco s Community Health Assessment identified that San Francisco has a population of 805,235 residents. Saint Francis Memorial Hospital s Implementation Strategy focuses on the Tenderloin neighborhood of San Francisco, which is one of the most densely, populated and impoverished areas of the country. Approximately 28,991 residents live in the 94102 zip code. Saint Francis Memorial Hospital s Implementation Strategy was developed based on the findings and priorities established by the City and County of San Francisco CHNA and a review of the hospital s existing community benefit activities and the Community Need Index data from Dignity Health. Saint Francis Memorial Hospital s Community Advisory Committee (CAC), the Community Board of Directors, and hospital leadership reviewed and approved the priorities of the Saint Francis Community Benefit Plan using the following guidelines: This plan is for a 3 year period and recognizes that many of the upstream contributing factors to health outcomes require a long term effort and commitment The strategies are to build upon assets and resources and are evidencedbased or best practice strategies, wherever possible. Work with our partners to align our efforts to enhance impact and to avoid unnecessary duplication of services. These strategies will take into account the Dignity Health goals and metrics and the SFMH Strategic plan. Primary focus on geographical area of the Tenderloin.

Major Needs and How Priorities Were Established Programs were developed in response to the current Community Health Needs Assessment and were guided by the following five core principles as established by the Saint Francis Memorial Hospital s CAC and affirmed by the Board: Disproportionate Unmet Health-Related Needs: Programs that focus on vulnerable populations who lack access to health care because of financial, language/culture, legal or transportation barriers, and/or who possess physical or mental disabilities. Primary Prevention: Address the underlying causes of persistent health problems. Seamless Continuum of Care: Linkages between clinical services and community health improvement activities. Build Community Capacity: Enhance the effectiveness and viability of community based organizations, reduce duplication of effort, and provide the basis for shared advocacy and joint action to address the structural problems in a community. Collaborative Governance: Engage diverse community stakeholders in the selection, design, implementation, and evaluation of program activities. 11 Saint Francis Memorial Hospital s CAC evaluated current programs and the ability, and opportunities to meet the needs of the community. The Committee affirmed that the health priorities and indicators identified through the City and County s Community Health Assessment, are reflective of the community served by the hospital and align with and complement other health improvement efforts at the local, state and national levels. Locally, current priorities align with the goals identified in Community Vital Signs, San Francisco s health assessment and improvement effort conducted in 2010. The 3 priority issues for the community are: 1. Ensure Safe and Healthy Living Environments 2. Increase Healthy Eating and Physical Exercise 3. Increase Access to High Quality Health Care and Services The rationale for these priorities is that social determinants impact health. From the assessment, access to food and ability to increase physical activity are limited in the Tenderloin neighborhood, as depicted by prevention quality indicators, ED utilization and hospitalization rates for these residents, which are high for almost every indicator. Description of What Saint Francis Memorial Hospital Will Do to Address Community Needs Action Plans Saint Francis Memorial Hospital will continue to be an active participant in the collaborative to improve the health in the City and County of San Francisco. This collaborative has set targets that are based on the citywide average, to show levels of acceptable improvement while also conveying the conviction of all San Francisco residents are entitled to the same standard of health and wellness. Some targets may appear especially ambitious; however, health equity and the disparities health inequities cause is a fundamental San Francisco value that drives decisions on resource allocation and intervention strategies. 1. Ensure Safe and Healthy Living Environments: Saint Francis current programs include Rally Family Visitation Services and Chronic Disease Self Management Programs. Proposed programs to support in the Tenderloin include pedestrian safety (e.g. Safe Routes to School Program), athletics, wellness and gardens/open spaces. 2. Increase Healthy Eating and Physical Activity: Saint Francis current programs include dietary interns, Ad Hoc Better Basics Workgroup, and