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

By Laura Kurtzman via

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.

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