The San Francisco Board of Supervisors created an Asthma Task Force, charged to advise the Board how to prevent asthma and to improve the quality of life for people with asthma, especially the underserved, who live or work in San Francisco. Department of Public Health serves as staff and voting participant to Asthma Task Force.
The public health concern being addressed focuses on a ten year plus pattern of asthma hospitalization discharge data showing local health disparities by ethnicity and geographic location. In addition, there is a high reporting of school days missed due to asthma flares. The community had a concern about the impact of asthma on medically-underserved children and adults, their families and communities, and the lack of coordinated response by city government to address the problem.
The Task Force focuses on responding to issues identified in the Strategic Plan as clinical, environmental, and schools/child care focuses. A Clinical Committee researches and makes recommendations intended to improve the clinical standard of care, reducing the burden on health caused by medically uncontrolled asthma, and the burden on health care systems caused by urgent care/ER visits and hospitalization. The Environmental Committee researches and makes recommendations to lessen environmental risk factors for asthma, particularly those needed in public housing developments and in the private rental housing stock. The Schools and Childcare Committee researches and makes recommendations to improve the SF Unified School District’s asthma management and education programs. These areas of need were determined by the strategic planning fact-finding process as well as the personal and professional experience of those serving on the Asthma Task Force.
Most asthma coalitions in the U.S. have originated from the need to generate and coordinate direct services to those affected by asthma. This Task Force does not provide direct services, but instead advocates systems change. Local legislation specifically appoints Task Force members to represent certain constituencies and charges them with:
Developing a comprehensive and coordinated Strategic Plan to effectively manage and prevent asthma in San Francisco;
Assisting and advising the Board of Supervisors regarding funding priorities, legislative action, and city asthma policies; and,
Advocating for federal, state, and local funding to support and sustain asthma prevention activities.
Agency Community RolesAsthma Task Force members are appointed by the Board of Supervisors to represent: community-based organizations; key government agencies; hospitals; HMOs/insurers; lung health/asthma organizations; health care professionals; childcare coordinating/ advocacy organizations; academia; community asthma advocates; persons with asthma or a parent of a child with asthma; property owner and tenant advocacy organizations; environmental health/justice organizations. Members should live in San Francisco or work in agencies that affect San Francisco residents. Many city agencies representatives are also appointed to the Task Force to serve in non-voting seats.
Members attend monthly meetings of the Task Force, and often bi-monthly meetings of the committees on which they serve. Committees are provided the support of an advocacy coordinator through grant funding administered by the American Lung Association.
The Department of Public Health (DPH) worked with community stakeholders to draft the authorizing legislation for the Task Force and the Board of Supervisors, to recruit interested parties to serve on the Task Force, to write and implement bylaws, and to guide community participants gaining an understanding of city government functions and procedures. DPH representative, Karen Cohn, is an active voting participant of the full Task Force, currently serves as Chair of the Task Force and of the Environmental Committee, and participates in the Planning and Clinical Committees. DPH also provides clerical support to uphold the requirements of public meeting law. Many efforts are made by DPH to foster collaboration, including publishing a newsletter for World Asthma Day illustrating the programmatic asthma efforts of community stakeholders.
Costs and Expenditures
Costs incurred by the strategic planning process include the following:Hiring of strategic planning coordinator and subsequent advocacy coordinator.
Work with public relations media consultant for press events.
Work with evaluation firm for conducting focus groups and retreats and analyzing results.
Photocopying and printing costs.
Extension of work timeline to implement advocacy strategies, which led to need to extend staffing term of service.
ImplementationOctober 2001 to March 2002, the San Francisco Asthma Task Force laid the ground-work for the Strategic Planning process.March thru November 2002, the San Francisco Asthma Task Force conducted a needs assessment for the Strategic Plan.
November thru December 2002, the Task Force developed recommendations for the strategic plan based on major findings from the needs assessment.
January to July 2003, the Task Force drafted the Strategic Plan and held hearings with SF Health Commission and Board of Supervisors; publicizing Plan via media advocacy activities on World Asthma Day.
Initial Phase Tasks:
Transition from community coalition to legislated task force, recruit diverse members and have them get appointed by the Board of Supervisors to specified seats of the legislated Task Force. Seek balance between community and health professional perspectives, and cultural/ethnic diversity representing the population of San Francisco.
Obtain grants and hire staff to support the Task Force efforts.
Create public meeting process, bylaws, officers and committees.
Conduct Strategic Planning information gathering via focus groups, key informant interviews, literature research and invited experts.
Invite selected guests to join in priority setting process and issue priority recommendations per committee.
Write and publish Strategic Plan giving background and priority recommendations.
Hold hearings with Health Commission and Board of Supervisors and media outreach to promote Strategic Plan release.
Regroup to create advocacy strategies for top two priority recommendations per committee.
Seek funding to maintain advocacy coordinator staffing.
August 2003 to February 2005, three Asthma Task Force Committees each researched and advocated for implementation of two Strategic Plan priority recommendations.
Second phase tasks:
Subsequently, offered School Committee’s resolutions and held hearings with Board of Education about proposed policy changes for SF Unified School District.
Pending, will offer resolutions and hold hearings with Board of Supervisors about Environmental Committee’s recommendations re. public and private housing conditions affecting tenants with asthma.
Pending, will meet with Director of Health to elicit support for Clinical Committee recommendations.
Implement advocacy strategies via Committee process; issue annual Progress Report to Board of Supervisors.
Continue to meet one-on-one with Board members and/or their aides to advise them on direction of Task Force advocacy and to elicit their support.
Third phase tasks:
Plan for and justify Task Force extension of sunset date and chart end point outcomes for each Committee.
Advocate for SFUSD to report on results and effectiveness of newly adopted policy changes after one year of implementation.
Advocate for SF Housing Authority to report on progress in reducing backlog of mold issues affecting public housing developments.
Advocate for SF Health Department to issue periodic surveillance of asthma hospitalization rates and ER use, institutionalize recommended interventions and report on effective interventions reducing measurable morbidity and mortality.
Costs were only sustained by private foundation grant funding. In-kind clerical and public notice support by Department of Public Health staff occurs without funding, based on legislative mandate. Stakeholder members participate without compensation, and are sufficiently committed to perpetuate the practice beyond the initial authorized period. The American Lung Association continues to seek grant funding supporting the advocacy coordinator position.