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San Francisco Department of Public Health
September 6, 2016
San Francisco’s Tenderloin Neighborhood:
Neighborhood Conditions & Health Status
2
Using a social determinants of health model, we will cover:
• Socioeconomic Factors
• Living Conditions
• Health & Well-Being
• Access to healthcare services
Framework for Assessing
Neighborhood Health
September 6, 2016SFDPH
3
Tenderloin Neighborhood of
San Francisco
Neighborhoods & Sup. Districts
• Tenderloin Population: 26,085 ± 1,216
• District: Mostly 6 & some of 3
• Zip code: Mostly 94102 & some of 94109
The Tenderloin has a slightly older and more
ethnically diverse population.4
Source: American Community Survey 5-year estimates, 2009-2013
32%
10%
18%
33%
6%
42%
6%
15%
34%
4%
0%
20%
40%
60%
80%
100%
White Black Latino/a API Other
Ethnicity
Tenderloin
San Francisco
0
20
40
60
80
100
< 5 5-17 18-24 25-44 45-64 65+
Pe
rce
nt
Age Groups
Tenderloin
San Francisco
Source: American Community Survey 5-year estimates, 2010-2014
The Tenderloin is one of San Francisco’s lowest income
neighborhoods – 1 in 3 residents live in poverty.
5
34%
64%
13%
29%
0%
20%
40%
60%
80%
100%
At or below 100% of CPT At or below 200% of CPT
Tenderloin San Francisco
Poverty
Source: American Community Survey 5-year estimates, 2009-2013
Housing is an important concern in the Tenderloin. Over
half of the City’s homeless population lives in District 6.
September 6, 2016SFDPH
6
Percent of Total Homeless Population:District 6 (TL): 57%
SF Homeless Count and Survey, 2005-2013
Program Highlight:
The newly formed
Department of
Homelessness and
Supportive Housing was
formed to better
coordinate resources to
help homeless residents
permanently exit the
streets and move into
housing and services
2,611
3,038
3,8363,844
3,398
2,850
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
2011 2013 2015
Ho
me
less
In
div
idu
als
Total sheltered and unsheltered homeless
individuals from General Count, 2011-2015
District 6 Remaining City
There is significant momentum to increase healthy
food access for all residents of the Tenderloin.
September 6, 2016SFDPH
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Percent of retailers that accept CalFresh benefits:Tenderloin: 57%San Francisco: 40%
Program Highlight:
The Healthy Retail SF
Program has worked to
convert five corner stores
into retailers that sell
healthy affordable food
and minimize the visibility
of alcohol and tobacco
products.
http://healthyretailsf.org
The Tenderloin has the highest rate of severe
and fatal pedestrian injuries in the City.
September 6, 2016SFDPH
8
Program Highlight:
Vision Zero SF is
refocusing city resources
and investment on the
streets that have the
most severe and fatal
traffic injuries so that we
can get to zero traffic
deaths by 2024.
http://visionzerosf.org
Pedestrian injuries – severe/fatal per 100 road milesTenderloin: 50San Francisco: 8
Crime and safety are important
issues in the Tenderloin.
September 6, 2016
9
Violent Crime Rate per 1,000 Residents:
Tenderloin: 260.3
San Francisco: 56.5
Program Highlights:
• DPH Mobile Crisis Team
provides on-site response
for prevention and
intervention after street
violence.
• The UCSF Wraparound
Project at ZSFG provides
support services to
violently injured youth
and young adults to
prevent future violence
and injury.
http://violenceprevention.s
urgery.ucsf.edu
Mortality
September 6, 2016SFDPH
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Leading causes of death, 2011-2015
Rank Tenderloin (94102) San Francisco
1) Accidental poisoning and exposure to noxious substances
Ischemic Heart Diseases
2) Ischemic Heart Diseases Dementias, Alzheimer's, and Other Degenerative Diseases of the Nervous System
3) Lung Trachea/Bronchial Cancer
Cerebrovascular Disease
4) Hypertensive Diseases Lung Trachea/Bronchial
Cancer
5) Dementias, Alzheimer's, and Other Degenerative Diseases of the Nervous System
Heart Diseases Other than Rheumatic, Hypertensive, or Ischemic
Source: CDPH, Death Statistical Master File, 2011-2015
The primary difference in mortality patterns in the Tenderloin is that accidental drug overdose is the leading cause of death.
Mental health and substance use disorder are
top health issues for Tenderloin residents.
September 6, 2016SFDPH
11
Source: OSHPD, Hospital Discharge Data, 2012-2014
Age-adjusted ER visit rates for adults 18yrs+ per 10,000 residents
Alcohol Abuse & Drug Poisoning
*Rates based
on preliminary
case
definitions, as
defined by
the Agency
for Healthcare
Research and
Quality.
227.34
119.89
58.10
23.18
0
50
100
150
200
250
Alcohol Abuse Drug Poisoning
Tenderloin
San Francisco
Self Inflicted Injury
35.11
9.85
0
5
10
15
20
25
30
35
40
Self Inflicted Injury
Tenderloin
San Francisco
Program Highlights: SF has numerous innovative behavioral health treatment programs. including the Community Justice Service Center, which links clients to case
management, housing, and other benefits and the Law Enforcement Assisted Diversion
(LEAD) Program that diverts low-level drug offenders to community-based treatment
instead of jail. In addition, naloxone is made widely available to reduce opiate
overdose deaths.
Tenderloin residents are hospitalized more often
for ambulatory care sensitive chronic diseases.
September 6, 2016SFDPH
12
Source: OSHPD, Hospital Discharge Data, 2012-2014
Age-adjusted hospitalizations rates for adults 18yrs+ per 10,000 residents
Program Highlight: DPH Primary Care Clinics participate in chronic illness quality improvement programs, including team-based approaches to hypertension and
diabetes. Tom Waddell Urban Health is a leader in developing chronic illness
improvement programs tailored to the needs to homeless individuals and those living in
supportive housing.
148.1
60.6
0
20
40
60
80
100
120
140
160
Tenderloin (94102) San Francisco
Preventable Chronic Disease
Hospitalizations-Age Adjusted Rate per
10,000 residents
Ambulatory care
sensitive chronic
diseases include:
Diabetes
Asthma
COPD
Heart Disease
Hypertension
The Tenderloin has a high rate of new HIV
diagnoses.
September 6, 2016SFDPH
13
SFDPH HIV Epidemiology Annual Report, 2014
189
83
0
20
40
60
80
100
120
140
160
180
200
New HIV diagnoses per 100,000
Tenderloin
San Francisco
HIV Diagnoses
(2013-2014)
64%
72%
0%
20%
40%
60%
80%
100%
Persons living with HIV diagnosed through 2012 who
achieved viral suppression in 2013
Viral Suppression
Tenderloin
San Francisco
Program Highlight: In 2015 DPH launched its Getting to Zero initiative with the goal of zero new HIV infections, zero HIV deaths, and zero HIV stigma by 2020. The initiative will
focus on continued funding for successful efforts and launching or expanding access to
PrEP (Pre-exposure Prophylaxis) , RAPID (Rapid ART Program for HIV Diagnoses), and
retention in care. http://gettingtozerosf.org
More Tenderloin residents have insurance as a result of
the ACA. Healthy SF remains an important resource.
September 6, 2016SFDPH
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Estimated Percent of residents enrolled in Healthy SF (2015)94102: # (~4%)San Francisco: # (~2%)
Healthy SF enrollment dropped by 75-85% between 2010 and 2015, in both the Tenderloin and Citywide, indicating more individuals moved to MediCal or health insurance through the exchange. About 4% of Tenderloin residents were still enrolled in Healthy SF as of December 2015.
7,539
3,065 2,847 2,681 1,407 1,115
57,260
47,18550,706
47,552
18,784
14,633
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
2010 2011 2012 2013 2014 2015
Nu
mb
er
of
En
rolle
es
Number of Residents Enrolled in Healthy SF,
2011-2015
94102
Total HSF
Compared to their proportion of the total
population, more Tenderloin residents access care
at ZSFG and DPH Primary Care Clinics.
SFDPH
15
September 6, 2016
An estimated 29% of Tenderloin residents are seen at DPH Primary Care Clinics
The most popular clinics are:
1. Curry Senior Center2. Tom Waddell Urban Health Center3. Larkin St. Medical Clinic4. Maxine Hall Health Center5. Positive Health Program at ZSFG
Source: SFGH/Clinicdata sets, FY 2015-2016
For FY 2015/16:
3%
% of City Population
11%
% of ZSFG/DPH Clinic Patients
Tenderloin
San Francisco
Primary Care Access
SFDPH
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September 6, 2016
SFDPH Primary Care Sites and Affiliated Partners
3 – Larkin Street Youth Clinic 4 – Curry Senior Center5 – Tom Waddell Urban Health Clinic6 – Medical Respite & Sobering Center
Maps and information gathered from SFDPH 2014-2015 Annual Report, available on the DPH website, at https://www.sfdph.org/dph/comupg/aboutdph/insideDept/OPP/docsreports.asp.
1 – Maxine Hall Health Center10 – Positive Health Program @ ZSFGH
Partner Clinics:• Healthright 360 @ GLIDE• St. Anthony Clinic• BAART Clinic
• Asian Pacific Islander Wellness Center
DPH Non-Profit Partners in the
Tenderloin
September 6, 2016SFDPH
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Addiction Research and Treatment Services
Asian & Pacific Islander Wellness Center
BAART Programs
Brilliant Corners
Center for Open
Chinatown Community Development Center
Community Awareness & Treatment Services
Community Housing Partnership
Curry Senior Center
DISH: Delivering Innovation in Supportive Housing
Episcopal Community Services
Felton Institute
GLIDE
HealthRight 360
Hospitality House
International Institute Of The Bay Area
Justice & Diversity Center, BAR Association of SF
Larkin Street Youth Services
Lutheran Social Services Of Northern Ca
Mercy Housing
Project Open Hand
Saint James Infirmary
Saint Anthony Foundation
San Francisco AIDS Foundation
Shanti Project
Superior Court – Community Justice Center
Tenderloin Neighborhood Development Corporation
Tides Center
Thank You
SFDPH
18
September 6, 2016
Meg Wall Shui - [email protected]
Michelle Kirian - [email protected]
