Engagement and immigrant affairs and sf government tv. Thank you, agnes. Then we also do have overflow seating in the chamber. Is that where we are doing it . It is being arranged presently. Folks can watch from there. Mr. Clerk, do you have any announcements. Please silence cell phones. Your completed speaker calls should be submitted to the clerk. Supervisor mandelman please call the first item. Clerk clerFood Insecurity ag lowincome pregnant people in San Francisco. Supervisor stefani thank you everybody for coming out this morning. I called this hearing because Food Insecurity in San Francisco particularly among lowincome pregnant women and families is a growing problem. Access to food should be a basic human right because it is a fundamental human need. It is limited or uncertain access t to add what food adequate food. People who are hungry or starving is something that affects every neighborhood in every community in this city. Economic insecurity is the primary cause for Food Insecurity. Almost 30,000 of the San Francisco children live in house hole holds below the poverty line. 12,000 of those children live in households earning less than 22,000 for a family of three. We know what it costs to live in San Francisco. We know that there are many thousands more than just those below the federal poverty line facing Food Insecurity. There is a host of government and communitybased programs including wic, calfresh, National School lunch program, school breakfast, Summer Lunch Program and child and adult care food programs. Despite these programs Food Insecurity remains high and continues to rise. In a survey on families on wic, more than half were Food Insecurity, more than half. The consequences can be dire and the stories are heart breaking. I know the story of one pregnant mother who only had enough money for one hamburger which she split between her two other children so she wasnt able to eat herself. Children need adequate nutrition for health, wellbeing and proper brain development. Pregnant women facing Food Insecurity are at extremely high risk for preterm birth. The cost of not being able to eat today can have permanent negative health consequences. In 2013 this board of supervisors passed the resolution recognizing food as a basic human right essential for human health and made a commitment to end hunger in San Francisco by 2020. That is next year. As we will hear today we will not meet that goal. Too often Food Insecurity is treated as a secondary issue. The purpose of this hearing is to bring clarity and focus to Food Insecurity and prioritize it in the same way we prioritize housing, homelessness and public safety. I want to thank martha ryan for bringing attention to this issue. I want to thank the public commenters who we hear from. It takes time, resources and courage to come and share your stories. Understanding your experiences is crucial to understanding this issue. I look forward to hearing for the departments here today and working with my colleagues and the community to get San Francisco back on track to ending hunger. I believe unless we have comments from my colleagues. I know that paula jones will be presenting from the department of public health. Supervisor mandelman before i call on supervisor walton the overflow room is ready, that is the Board Chamber. We cant have people standing in this room i will ask the folks standing go to the Board Chamber and watch and come back if you are speaking during public comment. The deputy can walk folks over there. Thanks everybody. Supervisor walton. Commissioner walton i know many of you know in district 10 there are several communities that dont have access to Quality Grocery Stores or nutritious food. I want to make sure we know and understand with Financial Support and Additional Resources some of our families have to travel miles to get to nutritious foods to get foods healthy for them and their families. I want to thank supervisor stephanie for highlighting the effects on expecting mothers and those impacts as we fight for Food Insecurity. I am looking forward to hearing from everyone hear. Good morning. I am paula jones with the department of public health. What i am about to present is really the voices of many different departments and organizations and many different people. I am here to share with you a summary of what is happening in our city. The number of people in San Francisco who are food insecure is going up. I want to stop for a second to thank you chairman delman and supervisor stephanie and supervisor walton. The number is going up. There is concentrated need among the pregnant people and also their children. We need to address this by focusing on the early life course. It is going to yield a lifetime of benefits. The most important thing to do is close and sustain the gaps for the most vulnerable and be sure we are prioritizing this population. Food insecurity and Food Security is essential to achieving all of the city goals for families. We have the ability to solve the problem. I am going to integrate voices of mothers who spoke during a citywide and yearlong initiative hosted by the Homeless Prenatal Program with Family Support services. Listen to the voices and be led by the people who live the experience of Food Insecurity daily. Supervisor stephanie provided a great definition and background. It means you always have enough food. Food insecurity means you have a lack of money and resources and affordable food in the neighborhood. It is challenging to eat healthy. Healthy food is expensive. Not having enough food impacts the entire household, not just one member. Being food insecure is because of not having money and the resources close to you. One food program is not enough to solve the problem. This impacts all sectors of society, especially health and education. It is severe in early life and they are lifelong impacts. Food and nutrition is critical to support a healthy pregnancy and developing baby. The first thousand days after conception are the most important time for brain development. It is between conception and two years old that 80 of the brain is developed. Future health risks, also, can be programmed during this early time of nutrition including obesity, hypertension and diabetes. Calories are not enough. Key nutrients needed to support nurral development are missing from lowincome pregnant womens diet. Cheap food is low in nutrients. Not having enough food at this time may lead to lifelong deficits in the brain. As supervisor stephanie said, Food Insecurity during pregnancy increases risk for diabetes. The impact so parents is very depressing, increasing anxiety and many mothers talk about the shame this they feel. It is time consuming to prepare food. As most of us not food insecure, we can eat out, do takeout, get delivery. These are all very expensive. For someone who doesnt have the money, they cant afford this. For children not centering enough food is connected to and anemia, poor academic achievement, increased hospitalization and more dental carries which negatively impacts attendance. Addressing this is integrated to achieving all goals for children and families. In 2013, the Food Security task ford, the board of supervisors task force issued a report and in response the board passed the aggressive charge and goal of achieving Food Security by 2020. We have made progress through increased investments in food programs and people with disabilities. We expanded existing local innovation. However, what we didnt anticipate was the dramatic increase in the cost of living and income inequality. It is now harder to afford basic needs. Last year the task force completed a report summarizing what we know about Food Security in San Francisco, data from programs and surveys where people were asked and larger sample sizes so we know using the questions to align with the u. S. Da Food Security module. Here is a summary of our recommendations. I have been monitoring San Franciscos food program data for over 15 years. What i saw in 2018, especially data points relating to children, were extremely concerning to me. The data for pregnant san franciscans was alarming. The food Program Infrastructure including for food preparation, warehouses, store rage is at storage is at capacity. We rely on them to deliver the programs. They are all at capacity. For our population level measures. What we know about Food Security across the city, we rely on data from the California Health interview survey. This is conducted by ucla through phone interviews and respondenneds answer respondents answer Food Security questions. This only ask to those below 200 of poverty for a Single Person that is a little less than 25,000 a year. For a family of four less than 52,000 a year. I want to acknowledge we know People Living in San Francisco above this level of poverty are struggling to meet basic needs. This graph shows more and more struggle to afford food. The number has almost doubled since 2005 because of population growth. Our Food Insecurity rates are above state average. Economic particularly affects our africanamerican community. They make up 5 of the population. 54 have incomes below 200 of poverty. These disparities must be addressed. They are very much concentrated in africanamerican communities. The next three slides show where there is concentration of low income families. This shows geographically by zip code where those with a live birth and received care through public insurance over the past five years live. Getting healthcare through public insurance requires having a low income. For someone pregnant 213 of poverty. The largest number is 94112 which mirrors other service trends. Next is 92124. Then 94110. In 2018 there were 2100 live births in San Francisco to people on public insurance. I have a problem with buses. The bus drivers wont let mothers go in with big strollers. That makes it difficult to take food like that. Now, this next slide is showing where the children who are enrolled in medical live and how many. Eligibility is about 266 of poverty. For a single parent less than 45,000 per year. With one child and family of four is 68,000. It shows where the children are in greatest needs. Dark is higher numbers of children. The importance of the next slide is the same kind of map showing children and young people under 18 years. The total number of that as of july 2019 was 4640. Now, important things that we learnelearned from the program t 50 of lowincome pregnant and 60s of the families are Food Insecurity. In a survey over 1,000 city college students. Food insecurity was very hi, 41 . With students with children it was higher at 53 or one in two. In a Different Survey on School Readiness 20 of those in kindergarten come to school hungry. We know when school is out there are fewery sources available to families over weekends and holidays. We learned the free dining rooms are seeing more and more families coming for free meals. Some have special areas in the dining room for families. I want to tell about the after School Supper program. This is a program that runs by sponsors located in after school programs. Now this program was sponsored by we have several, one was communitybased organization that provided after School Suppers to children in the southeast sector. One day they closed operations with no notice, leaving 1,000 children and families without this important resource. Because of Program Rules and because there were not very many sponsors, not enough to pick up that slack, no other organization could pick up those sites. Calfresh are the first line of defense against Food Insecurity and hunger. As supervisor stephanie read there are many programs. You have a summary and all of the rules from the Congressional Research service. Programs are supplemental. One program is not enough to assure a household food needs are met. There are Many Community and faithbased organizations with limited funds and distributing free groceries through a large food pantry operated by the Marin Food Bank including healthy childrens pantries in schools and daycare. They are governed by federal policy framework. It determines who is eligible, how much benefits are given, where food can be purchased where sites can be sited what is done with leftovers. Examining part of like one of the questions that i was asked to prepare for is the root causes and structural obstacles. The quote from the mother at the top. I am not financially stable. First comes the rent and the bills come and whatever money is left is for food. This is around affording basic needs and more residents are struggling. Now, the federal programs. This framework leaves many in San Francisco without food. There is a low power of benefits, the benefits equals 1. 40 per meal. This is a national problem. The urban institute found that across the country, the benefits were not adequate to meet the low income food needs for a meal in all of the counties, in 99 of the counties in the country including the district of columbia. Food costs in San Francisco are 30 higher than the national average. Funding isin adequate to run these programs. They are more than the federal reimbursement pays. It requires local funds to operate the programs. There is an impact we have put in many policy initiatives like increasing the minimum wage which is really important, and the impact of that, the School District the executive director of student nutrition services, jennifer, sent me analysis. When the minimum wage increase. In 2014, 62 of the kids qualify for free and reduced meals. The more you qualify for free you get more money from the federal government to pay someone who is qualifiered. In 2017 it dropped to 52 . They are feeding all of the kids but getting less reimbursement to do so. Eligibility restrictions. The quote tells the story best. It is stressful if you make too much you are not qualified but you need the help. You can be 20 over the limit and you wont qualify. We have new threats. As we all know with the new immigration rules around public charge, calfresh and snap, the National Name for the program, has been included what is considered a public charge. We have a new proposed rule that would eliminate this eligibility which streamlines the process. If you are qualified for one program you are automatically qualified for another. There is a proposed rule that would eliminate that. I want to just say again at the bottom just our food safety infrastructure is at capacity. Now, there are some promising practices that we can look to as we start to think about how we are going to recommit and address this issue. We can build on federal programs. I have examples for some of these. Colocating programs with the same population, make it easier for people, expanding the services, increase the reach and purchasing power. One example is when people use food stamp card at farmers markets they get a certain amount matched in dollars, some state and some local dollars. Some of the strategic local solutions. My favorite word at this point is and, meaning it is a good idea and we need to do that. We somewhere programs that are really sort of a universal approach to feeding everyone. It reduces barriers. At the School District they implemented Community Eligibility to feed everybody in 50 to 60 schools that is a universal approach. Another one is the food bank network. Everyone in need can come there. It is also important to target our efforts to address disparities, to have targeted programs for residents who need more. That is the more costly option. That is also part of the solution. Another recommendation is to adopt standard measurement for Food Security. We have much better information on specific populations. Our department of aging and Adult Services have all adopted this standard measurement. We need to really just monitor our systemwide use at programs and services and build on what we are doing and support Infrastructure Investments to expand food programs. I want to really leave with this is a slide of the voices of the mothers who participated in the focus groups with Homeless Prenatal Programs. We asked what actions can we take to improve your food needs . This is what they told us. I