Transcripts For SFGTV 20131216

Name is supervisor ferrel. I will be chairing the meeting joined by john avalos and scott wiener and Supervisor Malia Cohen many i would like to thank sfgtv for covering this meeting. Any announcements . The clerk yes, please silence all cell phones and electronic devices. Items for today will appear on the 2013 board of supervisors agenda unless otherwise stated. Okay. We have a number of items 19 and a hearing which is scheduled as item no. 10. We are taking that first. Please call item no. 10. The clerk item 130946 agenda[hearing impact of sugar sweetened beverages to the san franciscans health and health care sector]13094610. Sponsors mar; wiener and avaloshearing on the impacts that sugar sweetened beverages have on san franciscans health and the health care sector. 9 24 13; received and assigned to the Neighborhood Services and safety committee. 12 2 13; transferred to the budget the clerk sf 101234 thank you very much. This hearing was sponsored by supervisor mar and wiener and avalos. I will turn it to supervisor mar. Supervisor cohen as well. Let me just say that we are here in chambers looking at anls analyst report. We have dr. Richmond here today. Over a year broad base Community Coalition has been meeting with my office and supervisor cohen and avalos and supervisor has been meeting with a concerned group as well and concerned about sugar beverages and the health of our community. The risk of San Francisco families worries us. This is a study we have done and what our Budget Analyst Office has done is come forward and understand the impacts. I want to thank supervisors cohen and avalos and wiener. Its a very important issue. There is nothing more important than [inaudible]. To draft with supervisor wieners office and all of our staff are working on one measure that would move forward sometime in the future. Its not competing measures but one unified measure. This study helps us focus on different issues to unite the different groups working on this issue around the city. We are also looking on legislation out of this report that will help tax distributors of sugary drinks and allocate dedicated revenues to ensure the proceeds the revenues go to fight Heart Disease and liver damage. The purpose is to determine the cost of sugar drinks and by analyst and we have many Community Coalition folks and people from esteemed educational institutions. Rates are increasing citywide. Some rates in health and obesity are hitting pretty hard and especially some parts special in the in the southeast. From 20032005. The San Francisco adults among the latino from 14 percent to 27 percent, African Americans from 28. 5 percent to 32. 4 percent. This is especially important for the African American and latino communities. Its been a great pleasure to work with amanda and other staff have been great to work with as well in coming up with this report. Also christina gupta, a Senior Health planner has been a great advisor on this issue as well and Roberto Vargas from the university of San Francisco Health Policy program and dr. Laura smith who is a professor of Health Policy at ucsf who have been visors on this study and advising us on the impact of sugar sweetened beverages. At Public Comment i just want to acknowledge Beatrice Cardenas duncan who is a Community Leader and active with groups like shape up sf and the Labor Movement as well is here. Breks board of Education Board of education president is here. And corner store coalition and an organizer with t ndc and todd davis who has been a great leader in our neighborhood as well. They will be speaking at Public Comment. We also have a number of other folks from different communities that will speak a little bit later. Before i introduce the first speaker, i want to know if my colleagues have any opening remarks. Supervisor wiener . Thank you mr. Chairman and thank you supervisor mar for your work and your partnership on this important issue. The coalition that has been forming in San Francisco around the proposed sugary beverage tax is broad and deep. I will be honest that it is even broader and deeper than i thought it would be when we started this work. There are a lot of people in groups that i wasnt so sure if they would necessarily be supportive and i found that when you called them, there is not even a hesitation. There are people who in fact i thought might be opposed who when i called and talked to them they said of course, thats a no brainer. I think there is a reason for that. I think we are at a Tipping Point certainly in this city but i think in the country in terms of people understanding the very dramatic and negative Health Consequences of this countrys huge consumption of sugary beverages and consumption that has increased and increased as weve seen larger container sizes and more and more consumption. We have seen a steady stream of scientific studies directly linking consumption and over consumption to sugary beverages to contribute to diabetes and Public Awareness of the linkage between the beverages is literally through the roof and higher than i thought it would be. I want to thank dr. Richmond for being here. I know that richmond gets beaten up a lot for having the gull to go first and raising this issue and putting forth this proposal and fighting very hard to get a pass and i did not succeed in richmond but i think richmond deserves a lot of credit, dr. Riter man deserves a lot of credit. Sometimes when you go first, you dont always prevail but you lay down the groundwork for other people to come after and succeed which i think we will did here. We are seeing already as occurs everywhere that this proposal comes up, a strong reaction from the beverage industry. We already see and have heard about paid operatives from the american beverages in San Francisco and sometimes misinformation in our community. We know that you can have as many operatives as you want but in the end what we have to do is pretty straight forward is put out the facts and the science. The facts and the science around sugary beverages are straight forward and compelling. We know that weve had an explosion in diabetes, obesity and other Health Ailments related to sugary beverages. We know that in percentage of calories in our diet in terms of beverages has exploded just in terms of proportion of calories from sugar. The contribution to sugary beverages is almost half. We used to call it onset adult diabetes but we dont because these beverages are given to our kids. We know through scientific studies this kind of tax will reduce consumption of beverages and will save lives. We know that we are facing huge massive cost to the point where there are hospitals who are concerned about the future financial viability given to the explosion of diabetes. Despite the claims and argues about sugary beverage tax is a regressive tax, its a much higher tax that will affect these communities. This is a tax supported by Scientific Evidence by knowledge and im glad we have brought this forth with the board of supervisors. I look forward to hearing this. Good afternoon, everyone, thank you for being here and thank you for caring enough about not only your health but there is health of San Francisco. I want to get my thank yous out in case im not able to sit for the entire hearing today. But i want to thank you for your hard work and diligence on this report. It is incredible on what you have done and weve heard the facts on what will be part of this year. Hopefully by the end of this initiative, we will, our children will be spewing out facts and it is our goal to raise Peoples Awareness and i want to acknowledge the unprecedented number of educators all the way down to the clergy and to the people that are adversely affected by sugary beverages. Im excited because we have an opportunity to inspire other municipalities and other cities all across this nation to really take a hold of our health care. And policy of the Affordable Care act, and the other half paying attention to our diet and the third part being exercise. We will hear the statistics which are staggering when you know diabetes is a preventable disease and the birth defects and what liquid sugar does to the body and it is preventable and it is our responsibility as policy makers and leaders and more important as people of San Francisco to continue to provide Healthy Options for those folks that need them the most. Its no secret earlier supervisor mar laid out the statistics what we are dealing with the African American and latino and Pacific Islander community. Its not just this body taking up the cause but Leaders Within the ethnic communities that are also at the table. Finally we have statistics, support and data. This is going to be a very very interesting year i predict for 2014. So, mr. Chair, without further a do, lets get into this. Thank you. I want to thank from the American Heart Association thats been very helpful. Margaret fisher from the department of Public Health and janet cord row and maryann. Thank you. Supervisor avalos did you want to make remarks . Thank you, lets call our budget legislative analyst. Thank you very much mr. Bruce oh. Today well be presenting a report on the study of impacts of High Consumption of sugar sweets and beverages for the city and county of San Francisco. We have some slides if we can. Im just going to briefly introduce the report and then amanda guma from our office will walk you through details and we have Hammond Smith who will also be available for questions. We were asked to prepare a Scientific Research on the Health Risks Associated with the consumption of sugar sweet and beverages. Thats largely pertaining to obesity and diabetes and taking a look at the financial risk for the San Francisco residents. We have prepared analysis that identify cost that the city and county itself incurs and then the population of the city as a whole incurs that is separate from the city. Finally we are asked to review and report on policies explored and implemented by other cities either in terms of a tax on soda or other initiatives that have been under taken to address this issue. So thats the overview of the purpose of our report and now amanda guma will walk you through the details. Thank you to Hamilton Smith for the work on this. Thank you supervisors. As several of you have already noted there is extensive Scientific Evidence that we found in our research on the connection between consumption of sugary sweet beverages and chronic conditions particularly diabetes and obesity. As the American Heart Association found, maximum recommended consumption of sugars per day, added sugars per day for women is 6 teaspoons and 9 teaspoons for men. The regular drink has 37 teaspoons. Diabetes has increased and increase in rate of chronic conditions. The number of American Adults of obesity has more than doubled and diabetes has doubled and the percentage for children has tripled over the past 30 years. We want to better understand what those impacts are here in San Francisco. Using data that we found from the centers for Disease Control on prevention from 2010, we found there were 180, 955 obese adults in San Francisco and 46, 999 diabetic adults in San Francisco. Those populations are not necessarily distinct. So there is likely overlap between them. According to the agency for Health Care Research and quality, there is typically about a 54. 8 percent prevalence of obesity in diagnosed diabetes. We applied that rate to our San Francisco numbers to get a better sense of what those distinct populations likely are. Doing that we found there are likely 83, 249 obese adults in San Francisco and 46, 909 diabetic adults in San Francisco. In order to measure the cost related to the consumption of sugar sweet and beverages and the Health Impact that causes, we have to understand a few different factors. So, the first is the direct and indirect cost related to that consumption. Direct cost would be the cost of medical care that are directly related to the intervention. So inpatient visits, outpatient visits, drug care, etc. Indirect cost are related to work force productivity. These include absenteeism which is sick leave and disability and presentism. Which while being present at work, people who are suffering with these conditions are less productive during the workday. Additionally, we want to take our projections and take the final analysis and see how much of the cost is attributed to sugar sweet and beverages. We found two rigorous studies that developed, quantified the percentages to understand those cost projections. One is done here from the department of Public Health 2009 nexus study where they looked directly at the impacts in San Francisco of consuming sugary beverage and they found 86 percent of all the cost related could be attributed to sugary sweet and beverages. Similarly there were reports from the department of Public Health of illinois that looked at the diabetic population and they found a number of 8. 45 percent. This slide goes through some of the studies that we use to refer to in our methodologies from duke university, cornell, washington, American Diabetes association and the county. Cook county is in the chicago area. They did a study in 2010 looking at the diabetic population. As we look at the cost projections for the city of San Francisco, we look at two different things. We look at what the city spends in direct Health Care Provisions and services to the obese and diabetic populations. We also look at what the city contributes to Health Care Cost through health insurance, through the Health Services system for employees, retirees and dependents. Because we use several different methodologies we developed three scenarios which are outlined and detailed in our report to estimate the cost the city is currently spending to cover medical care related to obesity and diabetes that is attributable to Sugary Sweets and beverages. We look at the total cost, direct cost and indirect cost. We used for the analysis that you see on the table in front of you, the most conservative methodologies. So one of the studies that we looked at recommends using a 10 percent total medical cost attributable to obesity. The cost to treat obesity and the cook county study which we were just talking about references a 23 percent. Of total medical cost. We apply that in a few ways. One is looking at the total direct cost of medical care that the city spends annually. For that we use the general Fund Subsidies for San Francisco general hospital, laguna honda and healthy sf. The other two scenarios we were looking at the cost that the city of the employer contribution that the city makes to the Health System annually and taking those percentages of a cost and the total medical claims that the city pays out. You will see from the tables that using the estimates, we found a range of approximately 10. 8 million in estimated cost the city makes for Sugary Sweets and beverage consumption. We also looked at how much not only the city pays but San Francisco residents are paying for cost of sugary consumption. We looked to account for that prevalence of obesity and that diabetic population. We took that data from 2010 from cdc and applied that method ology in that way. We used the most conservative estimates we can find. These are looking at the annual additional cost per capita per both the Obese Population and diabetic population and we add those up and apply the percentages of and we came up with a total of 148. 1 million that San Francisco residents are paying for the cost of excess sugary beverages. Thats a conservative estimate and it would be much likely higher than that. Thats a conservative estimate. In the report we include a higher afro projection which is 61 million. Another rate, we werent able to find any methodology to quantify that is the risk to children. We think this is an important population to look at. As you can see on the table currently as of 2010, 32 percent of San Francisco children were over weight or obese. Studies show that 63 percent of obese children grow up to be obese adults. While those cost are not something we are experiencing now and we cant quantify now, if there isnt intervention into these childrens behavior there is a cost the city would experience later. Also notably ucla and the California Health study in 2011 found another 18,000 San Francisco residents that received diabetes or border line. 1 in 3 children are obese . That is correct. Those are not included in our calculations because they dont fit in those categories yet but we do think they are important numbers. The last piece of our report is with respect to children, i know that as discussed in the beginning in terms of children beyond obesity are children getting diabetes or prediabetes and we know that once someone whether you are a kid develops prediabetes you are on your way and we are hearing more and more about kids in high school having not just prediabetes but full on diabetes and when you speak to pediatricians and disadvantaged part of the city with prediabetes or full diabetes. Its stark. Yeah. We found some statistics that showed approximately 3600 cases of childhood diabetes diagnosed annually. Can i just throw in another question. I know that robert from uc sf pointed its not just diabetes and obesity but also liver damage and other Health Problems and you are not even tracking that. Its probably even a much bigger problem than the data that what you are showing. That is correct. There are probably a list of 10 chronic conditions that the Scientific Evidence pretty extensively can connect to consumption of sugary sweet and beverages that we didnt quantify the Health Impacts and foreman impacts and those include cardiovascular conditions and toxicity. Again, we believe the estimations that we are providing are conservative. The last section of our report we were asked to rook at other legislative sections of the state. We looked through the cities around the country. To date none of them have succeeded. In addition we looked at efforts in other states on the state level, we found many attempts and some really small excise taxes put into place but nothing significant yet has passed. Internationally probably many ofu been reading about the recent effort in mexico which to date has been successful. That is a tax on soda at 0. 08 per liter in addition to a 5 percent sales tax on other junk food. We will be watching that progress. In terms of the united states, to state to date it has not been successful in this regard. Thats the end