San Francisco Department of Public Health, Program on Health, Equity, and Sustainability
The Central Market/Tenderloin Data Portal
The origins of the Central Market/Tenderloin (CMTL) Data Portal are rooted in intersectoral partnerships and a desire to create equitable, environmental change. The Central Market Street corridor and Tenderloin neighborhood is one of SF's most vulnerable regions. It is home to roughly 36,000 residents, of which 72% are persons of color and 31% live below poverty. The preventable ER admission rate in the CMTL is more than twice the city average, and the ER admission rate for alcohol abuse is more than four times as high. This is largely due to the density of supportive housing for formerly homeless individuals. However, this part of the city is also home to many low-income and immigrant families, and the CMTL has more youth per square mile than any other part of the city.
These individuals live in an environment with significant social disorder. Rates of violent and property crime, street and sidewalk cleaning orders, and traffic injuries are among the highest in the city. The complex challenge of supporting a healthy environment for all in this milieu is the reason Saint Francis Memorial Hospital and its foundation decided to initiate the Tenderloin Health Improvement Partnership (TLHIP) as part of its requirement to demonstrate community benefit. TLHIP is a multi-sector collective impact partnership committed to improving health and well-being in the Tenderloin by aligning priorities, resources and activities to create pathways to health for residents.
At the same time, The Office of Economic and Workforce Development (OEWD) was updating its economic strategy for Central Market Street to include the adjacent Tenderloin neighborhood, whose low-income residents were beginning to experience impacts from the large technology companies that had been incentivized to set up shop on its border. Companies like Twitter, Zendesk, and Square had brought thousands of new employees into an area that had historically been ground zero for some of San Francisco's greatest challenges, including homelessness, drug use, and violent crime. The updated Central Market/Tenderloin Strategy aimed to create strategies to capitalize on new investments to create a healthy, mixed-income neighborhood that offers safety and well-being to all residents, workers, and visitors. The Strategy focused on developing a community impact framework that centered on cultivating economic opportunities, ensuring clean and safe shared spaces, and supporting a thriving low-income community unlike it's predominantly economic development focused predecessor
At the time, staff from the San Francisco Department of Public Health's Program on Health, Equity and Sustainability (PHES) were working with both organizations, supporting some of TLHIP's data needs and collaborating with OEWD on a health impact assessment (HIA) of single resident occupancy (SRO) hotels. It was clear that there were many overlaps between these two initiatives and that additional synergy and coordination could be valuable. While both the CMTL Strategy and TLHIP had developed evaluation plans, there were few internal resources to support ongoing evaluation to inform program implementation. Recognizing that both initiatives were aligned with the PHES mission, we offered our ongoing support for evaluation activities.
PHES staff proposed to develop a shared, web-based data tool that could support the ongoing evaluation needs and collective impact work of both initiatives. The goal was to create a product that would allow our partners to drill down and ask questions like where in the neighborhood do we see the most sidewalk cleaning requests?â€ while also tracking change over time enabling coordination and efficient deployment of resources. We also wanted to ensure that measures were being explicitly connected to the work that was being done, so that gaps could be identified or new partners could find opportunities to collaborate. That's why on each data page there is a section on relevant programs and projects.
The tool was launched in November 2017. We launched our communications plan by presenting to the TLHIP Community Advisory Committee, comprised of some of the most influential community organizations in the Tenderloin, and it was greeted with much excitement and interest. Our plan is to start increasing awareness on social media and to host a Tenderloin Data Day in 2018 to provide guidance on how to answer community questions using the tool's online mapping functions. The CMTL Data Portal is intended to support collective impact efforts to improve social determinants of health in the Tenderloin neighborhood. Results from collective impact can take time to realize (particularly in relation to chronic disease), but so far community surveys seem to indicate that residents feel that the neighborhood is improving and they feel safer. CMTL Data Portal: http://cmtldata.org/.
The Tenderloin neighborhood and Central Market Corridor are home to many of San Francisco's most vulnerable residents. It is home to roughly 36,000 individuals, of which 72% are persons of color and 31% live below poverty. For almost all measures of health, people who live in the Tenderloin fair the worst. The preventable ER admission rate is more than twice the city average and the ER admission rate for alcohol abuse is more than four times as high. This is largely due to the density of supportive housing for formerly homeless and very low-income individuals. However, this part of the city is also home to many low-income and immigrant families, and the CMTL has more youth per square mile than most other parts of the city. These individuals live in an environment with significant social disorder. Rates of violent and property crime, street and sidewalk cleaning orders, and traffic injuries are among the highest in the city, and open-air drug use is endemic.
The needs and rights of the various, disparate populations in the Tenderloin are often at odds, and historically there has been no cohesive neighborhood voice. Groups representing families often find it challenging to find common ground with groups that represent the rights of homeless adults and those struggling with substance use disorders.
At the same time, this part of San Francisco is rapidly changing. In 2012, San Francisco offered tax breaks to technology companies that agreed to move their businesses to properties on Mid-Market street, which borders the Tenderloin neighborhood. These companies included Twitter, Dolby, and Zendesk, among others. In the nearby South of Market and Financial District neighborhoods, numerous other established and start-up technology companies also set-up shop. Between 2011 and 2015, San Francisco saw a 20% increase in the number of jobs and the Central Market/Tenderloin saw a 22% increase. While there are many positive aspects to this boom of economic activity, there are also many associated challenges, chief among them being insufficient housing supply and housing affordability. Between 2011 and 2017, the cost of a two-bedroom apartment in San Francisco nearly doubled.
Despite its central location, the Tenderloin has historically been one of San Francisco's most affordable neighborhoods, primarily because of the density of permanently affordable housing and a reputation for neighborhood disorder. However, its rent controlled and market rate housing have not been immune to the impacts of the recent housing squeeze. Between 2011 and 2015 there was a dramatic jump in the number of eviction notices served to residents â€“ an indication that landlords are trying to free up rent-controlled units to collect market-rate rents. Instability and unaffordability of housing can have significant impacts on household stress, ability to pay for basic needs, and the habitability of housing conditions. Anecdotal reports indicated that this was indeed true for many low-income residents in the Tenderloin.
The confluence of historical distress and growing outside pressure to see neighborhood improvement inspired recent efforts to harness new investment in the area to create a diverse, healthy, mixed-income neighborhood that offers safety and well-being to all who live in, work in, and visit the area. This goal was the impetus for the Tenderloin Health Improvement Partnership (TLHIP), a collective impact effort headed by Saint Francis Memorial Hospital and its foundation, and the Central Market Tenderloin Strategy (the Strategy), led by the San Francisco Office of Economic and Workforce Development (OEWD). The objective of both initiatives is coordination and alignment of services.
The work of both groups in many ways came to fruition in 2014 with the reopening of Boeddeker Park. Boeddeker had a long history of open air drug sales and use, and was generally unusable for those that wanted to enjoy usual park activities. After a $9.3 million-dollar renovation, and significant support and coordination from both TLHIP and OEWD, the park re-opened with a plan for continuous stewardship and programming by the Boys and Girls Club. Today the park provides activities for all residents in the neighborhood, including a space for PE classes for local schools, fitness classes for immigrant seniors, walking groups for formerly homeless adults, and a meeting space for community organizations. It is a neighborhood treasure that everyone is fighting to protect and has sparked conversations about how public space can be accessible and safe for everyone. Building off of the momentum from this success, TLHIP and OEWD have gone on to accomplish numerous other achievements, including strengthening the formerly lifeless Community Benefit District into a neighborhood leader, stabilizing and growing the Safe Passage Program that provides corner captains to make sure that children get home from school safely, revitalizing existing neighborhood businesses and filling vacant storefronts, supporting the Tenderloin Development without Displacement Project, and starting a citywide conversation about safe injection facilities. Early neighborhood safety surveys conducted by TLHIP indicate that many residents feel that the safety and quality of the neighborhood is improving.
The San Francisco Department of Public Health, Program on Health, Equity, and Sustainability (PHES) has been engaged with both of these initiatives since their inception, primarily by providing data and evaluation assistance. While both TLHIP and the Strategy revolve around coordination and alignment, TLHIP is explicitly a Collective Impact initiative. This means that they organize activities around five key elements: a common agenda, a shared measurement system, mutually reinforcing activities, continuous communications, and backbone support. It seemed apparent that there was an opportunity to further connect the work of these non-profit and public efforts by creating a shared outcomes measurement system that both TLHIP and OEWD could rely on. PHES staff have extensive experience with creating health in all policies data tools, including the San Francisco Indicator Project and TransBASE SF, so we proposed to use a CDC Health Impact Assessment grant to create an online shared data tool that would merge most of the outcomes measures from each of their evaluation plans and allow for interactive data analysis, trend tracking, and the connection of different activities to each indicator.
In November 2017, the Central Market/Tenderloin Data Portal was launched. The Portal contains 35 data pages in five different content areas that represent the blended focus areas of the TLHIP and the Strategy: demographic context; economic opportunity; neighborhood cohesion, stability, and affordability; resident health and wellbeing; and safe and healthy shared spaces. All data pages provide interactive charts and text sections on why the data is important to neighborhood wellbeing and interpretation of results. Most pages also contain interactive web maps, that allow for data summarization around points of interest and filtering of features, with the goal of supporting targeted geographic responses. Pages also contain a section on what is being done to address this issue?â€ with links to activities that are being supported by either the city or TLHIP to move the indicator in a positive direction. We are now rolling out our communications plan. So far, we have presented to the TLHIP Community Advisory Committee, comprised of some of the most influential community organizations in the Tenderloin, and were greeted with much excitement and interest. Next we will be increasing awareness on social media and to host a Tenderloin Data Day in 2018 to provide guidance on how to answer community questions using the tool's online mapping functions.
While many other online community indicator systems exist, we believe that that the CMTL Data Portal is innovative for several reasons. First, the data are presented not just for the purpose of presenting useful information, but to guide two collective impact/neighborhood coordination initiatives in planning and monitoring their work. It is based on evaluation plans, with commitments to working on change. Secondly, this effort is a collaboration of multiple city agencies and a non-profit hospital. While all non-profit hospitals must show community benefit, few chose to engage in addressing the social determinants of health in their surrounding community. Even fewer have such extensive intersectoral collaborations. This rarity was recognized at the 2017 SF Mayor's Data and Innovation awards when SFDPH, OWED and SF Planning were awarded the Bridgebuilderâ€ award for successful collaboration with different departments or external groups. Finally, the Data Portal provides interactive features that allow users to answer very specific questions instantaneously. Questions like how many drug crimes occurred within 200 feet of Boeddeker park in 2015?â€ or how many 311 requests for urine and feces removal were made within 500 feet of this homeless shelter in 2015?â€ It also allows for tracking of demographic change and the distribution of housing by affordability. We hope that these features will support better targeting of resources and coordination of organizations working to achieve similar goals.
In addition to being innovative, we also believe that the Data Portal aligns with various evidence based practices. In many ways, the Data Portal process is similar to PACE EH, in that we have characterized the community, defined goals and issues, developed indicators, and have set priorities for action, with ongoing evaluation of progress. Additionally, the objectives within the Data Portal are aligned increasing mixed income housing as promoted in the Community Guide and indicators for reducing indoor environmental hazards from Healthy People 2020.
Links to the organizations and websites listed in this summary can be found at the following links:
CMTL Data Portal: http://cmtldata.org/
TransBASE SF: http://transbasesf.org/transbase/
SF Indicator Project: http://www.sfindicatorproject.org/
Program on Health, Equity and Sustainability: https://www.sfdph.org/dph/EH/PHES/PHES/default.asp
Central Market/Tenderloin Strategy: http://investsf.org/neighborhoods/central-market/
Nutrition, Physical Activity, and Obesity|Motor Vehicle Injuries
The goal of the Central Market/Tenderloin Data Portal is to support the shared measurement efforts for the Tenderloin Health Improvement Partnership (TLHIP) collective impact project and San Francisco's Central Market/Tenderloin Strategy (the Strategy). Shared measurement is one of the five key elements of Collective Impact and ensures that efforts remain aligned and participants hold each other accountable. We also had the goal of providing interactive data that could allow for improved targeting of interventions. To achieve these goals, we used a CDC Health Impact Assessment (HIA) grant to support building a Central Market/Tenderloin data working group, headed by staff from SFDPH and comprised of staff from the San Francisco Office of Economic and Workforce Development (OEWD), the San Francisco Planning Department, Saint Francis Memorial Hospital, and the Saint Francis Foundation. We met monthly over a year to work on combining goals from the two initiatives, distributing the measures from each evaluation plan within those blended goals, and determining which measures were missing.
When we began, OEWD three goal areas within their evaluation plan: economic opportunity, clean and safe shared spaces, and supporting a thriving low-income community. TLHIP on the other hand had six goal areas: economic opportunity and affordable retail; active vibrant, and clean shared spaces; housing access; community engagement and neighborhood voice; behavioral health; and resident health. It is evident that there is significant overlap between these lists, so we were able to get to four shared goal areas: economic opportunity; clean and safe shared spaces; neighborhood cohesion, stability, and affordability; and resident health and wellbeing, in addition to a section on demographic context. We next went through the process of shuffling indicators around and determining where there were gaps until we got to a list of about 44 indicators presented on 35 data pages.
After the indicators were chosen, we went through the process of collecting and analyzing data from three years, 2011-2015, with the intention of updating the data for each odd year. We then created text for each indicator page describing the relationship to health, interpretation of time and geographic trends, and curating a list of TLHIP and City projects that are trying to move the indicator in positive direction. We then built interactive web maps using the ArcGIS online platform and interactive charts using Highcharts. We used the money from the CDC HIA grant to pay for a web developer to a built a site where the content could be presented. We are now in the communications phase. The site has been piloted for the TLHIP Community Advisory Committee (TLHIP CAC), which includes many prominent partners from the community, including: The Tenderloin Community Benefit District, the Boys and Girls Club, the Saint Anthony Foundation, Glide Memorial, Healthright 360, the Tenderloin Neighborhood Development Corporation, and others.
In total, this process took about one and a half years. The primary collaborators in this process were OEWD, the evaluation lead from the Saint Francis Foundation, the SF Planning's community development specialist assigned to the Tenderloin, and SFDPH. Our work on this project was heavily grounded in the wisdom of the TLHIP CAC and the city working groups organized by OWED. In both cases, community and agency partners were heavily involved in the construction of the original evaluation plans. We also presented during the development process to the CAC in order to get feedback.
In terms of cost, staff time has all been provided in-kind. This included 18 one hour meetings, and over a year of staff time spent doing data analysis and website construction at about 30% FTE. The only funds that were spent on this project were $9,000 for website design, contributed from the CDC HIA grant. Future maintenance of the site includes a $16,00 work-order from OWED to support SFDPH staff time on data analysis and presentation to use for their bi-annual report card. Additional funds may be provided by the Saint Francis Foundation to support dissemination efforts, such as a Tenderloin Data Day, where we provide hands-on technical assistance for using the Portal.
The goal of the Central Market/Tenderloin Data Portal is to support the shared measurement efforts for the Tenderloin Health Improvement Partnership (TLHIP) collective impact project and San Francisco's Central Market/Tenderloin Strategy (the Strategy). Shared measurement is one of the five key elements of Collective Impact and ensures that efforts remain aligned and participants hold each other accountable. We also had the goal of providing interactive data that could allow for improved targeting of interventions. To achieve these goals, we used a CDC Health Impact Assessment (HIA) grant to support building a Central Market/Tenderloin data working group, headed by staff from SFDPH and comprised of staff from the San Francisco Office of Economic and Workforce Development (OEWD), the San Francisco Planning Department, Saint Francis Memorial Hospital, and the Saint Francis Foundation.
We were able to successfully collaborate to create a shared outcomes measurement tool that has the interactive features that we desired. It is still too early to assess its impact on the work of TLHIP or OEWD; but thus far, it has been useful in applying for grants. We have not formally evaluated the development process or the tool, but plan to integrate questions about the value of the tool into the annual collective impact survey administered to members of TLHIP.
As for many projects, the sustainability of the Central Market/Tenderloin Data Portal is dependent on funding. Fortunately, we have come to an agreement with the Office of Economic and Workforce Development to provide a $16,000 work order each year to fund the work of a Health Program Planner to update the data on the portal and produce a report, for each odd year. Additional analytic support will also be provided as well as in-kind support from a Senior Epidemiologist. Support for community engagement and custom images will be provided by the Saint Francis Foundation.
We have learned many lessons through this process. One is that public health departments can be useful liaisons for health focused institutions hoping to partner with other city agencies. Public health departments can form alliances through common health goals with healthcare providers, as well relationships with other departments through a sense of being part of a larger government family. In that sense, they can sometimes be the glue to hold unlikely relationships together or to facilitate communications. Another lesson learned is the need to keep measures relevant to initiative commitments and to not fall into the trap of looking at every interesting dataset. Our project did a relatively good job of only adding measures where there was a commitment to address the issues at hand. Lastly, developing a website can be tricky and lengthy. We had a relatively small amount of funding and had to be satisfied with the features that we could afford. Choosing a web developer with a portfolio of similar products would be advisable.
We believe, at this time, there is sufficient interest and excitement around using the CMTL Data Portal that it will continue to be maintained, used, and improved upon for years to come. The existence of the TLHIP CAC provides easy access to feedback that will help us to continue to improve the Portal and the grant making nature of OEWD and TLHIP should enable on-going financial support.
Colleague in my LHD|E-Mail from NACCHO