EVCP Expresso – September 2018

September 4, 2018

Dear Colleagues:

Now that the academic year is essentially in full swing, I hope everyone has had at least some exciting adventures along with peace and quietude over the summer.

On to the Expresso topics this month:

Have you ever thought about what you would do if you had to live in the city for 24 hours without the necessary resources to secure food and shelter? What about 48 hours, a week, a month, maybe a year? Confronting and defeating the housing crisis and its detrimental impact on the most vulnerable within our community is daunting, but this month, I’ll cover the critical work of many at UCSF towards this effort.

What do the consequences of homelessness, gun violence, opioid addiction, and obesity have on the overall population? You’ll read about a promising initiative to gain more insight into population health and stimulate collaboration towards addressing many of our current and oftentimes overwhelming challenges.

And to help us succeed in these and other important endeavors, I want to give you another update on what Chris Shaffer and his team at the Library have been planning on our behalf.

Let’s begin:

As always, please send me your thoughts on these topics and feel free to share ideas for future issues of Expresso at [email protected].

Best wishes,



Research, Education, and Advocacy: Working together to combat homelessness

UCSF is no different from any other part of San Francisco. We see daily at our various locations the extent and severity of the housing crisis and its impact on the thousands of people who have nowhere to live but on the city streets and in its parks. This is a burning issue that has been occupying the minds of UCSF leadership for some time now, and I want to let you know about a number of initiatives underway at UCSF that are helping individuals affected by homelessness.

We’re working on this in several areas across our university – within research, advocacy, education, and patient care. The School of Nursing, for instance, is studying the impact of homelessness on birth outcomes, while others are investigating the roots of the crisis itself. We have advocates at UCSF who are working with policy makers and nonprofit partners. Researchers at UCSF Benioff Children’s Hospital Oakland are developing novel models of care for children in homeless families. And students in all four schools engage in a number of community service learning experiences, ranging from educating high school students to participating in health care activities.

Have you read “The Crisis in Our City: Tackling San Francisco’s Dire Homelessness Problem”? It’s an article in the summer installment of UCSF Magazine about Department of Psychiatry Chair Matthew State’s perspective on the homelessness crisis. If you haven’t, take a few minutes to check it out.

“This is a city that has taken on enormous problems before and we can do it again,” Matt says, noting how academia, philanthropy, the nonprofit community, and government came together in the 1980s to tackle the seemingly insurmountable challenge of AIDS. At that time, the UCSF SFGH partnership played a critical role. And today, the UCSF connection with Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG) is just as important and, thankfully, is bolstered by further partnership with Citywide Case Management, which provides services and training to unhoused people living with persistent mental illness.

I also checked in with some of our other colleagues who are at the forefront of combatting homelessness: Margot Kushel, director of the UCSF Center for Vulnerable Populations and physician at ZSFG; Adri Jayaratne, Matt’s chief of staff in the Department of Psychiatry; and Galen Laserson, senior project director in that department.

Margot is amazing. She dispels a lot of myths and assumptions about homelessness. Be sure to read her excellent piece in “The Conversation,” an online news forum. I don’t have the space for all of her insight – just know this: Homeless people don’t move here; people become homeless while living here. No surprise – the biggest cause of homelessness is the lack of affordable housing. People in poverty live at risk of just one crisis plunging them into homelessness. Many people become homeless not because of substance abuse or a mental health crisis, but because of the housing crisis. However, people suffer so much trauma on the streets that it triggers or exacerbates those problems.

“Homelessness has such devastating impacts on health,” Margot adds. “Because we’re a public health and biomedical sciences university that takes its mission seriously, in a city that is in many ways the epicenter of the homelessness crisis, we have many ways to be involved.” One example is to use our positions as researchers and health care providers to advocate for solutions. “I spend a lot of time explaining to legislators that, ‘Housing is the best medicine, and that nothing we can do is as impactful as housing.” You’ll hear more from Margot at Chancellor Sam Hawgood’s State of the University on October 30th in Cole Hall, noon – 1 p.m.

In addition, the Department of Psychiatry is working closely with the city and Tipping Point Community, a major San Francisco philanthropic organization, to build upon our current partnerships and develop a game plan to address homelessness head on. Adri says the goal is for UCSF, the city, Tipping Point, the private sector, and other philanthropic partners, among other players, “to figure out collectively what we can do…. There really hasn’t been that kind of coordinated effort, with getting everybody together to do this, and our hope is to solve this problem.” Contact Adri for ideas and opportunities to get involved. All help is needed and welcome.

Here's a great example. When Mitch Katz (formerly of UCSF) was Director of Public Health, he created a division of housing within the Department of Public Health. They created thousands of units of permanent supportive housing using the Housing First philosophy. Instead of making treatment a prerequisite to housing, individuals are housed first. Once that happens, more than 80 percent successfully stay housed.

Besides the high cost of housing that affects everyone, one of the major obstacles to defeating homelessness is NIMBYism. While we have the expertise and know-how to treat mental health and substance abuse problems, the “not in my backyard” phenomenon prevents us from most effectively using that knowledge. Can we educate and inform towards changing NIMBY attitudes? We have to try.

If this has sparked a desire in you to volunteer, check out the UCSF Wellness & Community volunteer portal.

Dr. Martin Luther King, Jr., once said, “Our lives begin to end the day we become silent about things that matter.” Fight the inertia, speak out, take action, and most of all, show compassion.

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Population Health: We can see the forest and the trees

Reducing health inequities and working to improve population health are core priorities at UCSF, an important and straightforward statement with which I’m quite sure we can all agree. The concept of “population health” – of looking at health issues at the population level – has been gaining steam for the past decade, and many schools of public health have refashioned themselves into population health institutions. I think the idea not only makes a lot of sense, but also is an arena in which UCSF has historically excelled and can continue to make its mark.

We’ve already become a leading force of new science in this area. Perhaps it’s not recognized nor understood as well as the basic sciences that have generated our Nobel Prizes, or the clinical care that gets us rated the best hospital in this part of the country. But so many people on campus are doing impressive work in this area and making great impacts in terms of research, programs, and policy.

Last year, School of Medicine Dean Talmadge E. King, Jr., announced the appointment of Kirsten Bibbins-Domingo as the inaugural Vice Dean for Population Health and Health Equity. An initial planning group, comprised of Nancy Adler, Robert Hiatt, Claire Brindis, Elizabeth Watkins, Kevin Grumbach, and Jaime Sepulveda, has now become a formal Director’s Group under Kirsten’s leadership, with the addition of Tung Nguyen, Kelly Knight, Wylie Liu, Ami Parekh, Margot Kushel, and Olivia Herbert. The Population Health and Health Equity Initiative is off to a strong and promising start. The initiative is also aligned with “partnering to achieve health equity, one of the three grand challenges of UCSF: The Campaign. You can see that it will take a lot of expertise and people from many disciplines to be successful.

Why address this challenge now? Because we can – we’re able to connect the dots thanks to advances in science and technology.

In fact, as Claire notes, “Our faculty have been conducting social, behavioral health, and health policy studies for decades – for example, social epidemiology, how stress factors affect health outcomes, and the value of community partnerships in improving health.”

Also, as Bob says, “Science has progressed. We have a better understanding of the complexity of health and disease that is dependent not only on biologic processes, but also on the psychological and social context that people live in. Where and how people live, work, and play has an increasingly understandable impact on people’s health. Homelessness, climate change, incarceration, obesity, discrimination, racism, food insecurity are not normal territory for health care workers, but we believe, in the era of population health, it’s our responsibility and in our wheelhouse to think about these things.”

“I think of this as a river, a continuum,” Claire adds. “We’re not just responsible for our patients in the clinical setting – we also have responsibility when the patient is elsewhere. The next part of the river or continuum are issues that are going on in the community itself that contribute to the overall health and wellness of the overall community, which in turn, impact our patients. Researchers are now looking at unstable housing and homelessness, for instance, as part of the scope of health care that we deliver.” (See previous story!)

And, related to our training mission, both Dean Elizabeth Watkins and Executive Vice Dean Catherine Lucey have incorporated population health aspects in preparing the next generation of leaders. Liz has worked with the directors of the six postdoctoral programs in social and population sciences to form a consortium, called Soc/Pop, to serve as a hub for joint programming, expanded research and mentoring opportunities for students, and improved fundraising prospects to support students in those fields. More recently, Catherine has made population health one of the lenses for training in the new School of Medicine Bridges Curriculum.

Keep in mind that this is primarily a forward-looking endeavor. Other ideas in the works:

  • Because population-related sciences often need access to and maintenance of large data sets, faculty across UCSF will soon be asked to assess their research data needs and assets.
  • After a successful colloquium in July (it’s on YouTube in three parts – check it out!), efforts are being targeted at “wrestling the big hairy problems” (as Bob puts it) like obesity, opioids, guns, racism, immigration, and homelessness.
  • More intellectual collaboration and scholarly sharing – by groups on campus who may not even know about each other yet – will be encouraged and fostered.
  • The initiative also will serve as a platform to consider incorporating additional content into educational and training opportunities, not only within existing programs, but maybe also in a new post-doctoral program in population health.
  • An online presence is critical, so be on the lookout for a new website where people interested in getting involved can get more information.

And what’s further down the line? Population Health will play a big role as we advance further into this age of precision medicine. It’s now clearer than ever that deciphering health and disease at the level of the genome or the cell will require a deep understanding of the impact of external and environmental factors on an individual’s health – something that can only be tackled by amassing and analyzing huge data sets from large populations and bringing many disciplines together to study these important problems. See this recent article in the Lancet, “Reimagining population health as convergence science.”

It’s kind of mind-blowing, right? Think you might be working on something that the team should know about? Please let them know!

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Library strategic plan: Exciting things on the horizon

In “Beyond Books: The Library of the 21st Century,” I covered the evolving nature of the Library. Thankfully, one thing that won’t change is the Library staff’s unflinching embrace of big ideas, collaboration, and growth. Put the two together and we get a bold new strategic plan that will direct the Library toward an exciting future. To guide them in this endeavor, University Librarian and Assistant Vice Chancellor of Academic Information Management Chris Shaffer and the Library staff have crafted a set of objectives that I am eager to share:

  • Education: Develop a coordinated education strategy in support of all UCSF mission areas with a focus on open science and data science. Promote shared governance of education technology that stimulates outstanding development and support of shared systems.
  • One Library: Ensure that every UCSF patron of the Library has an equal opportunity to receive the best we have to offer. No matter who you are, where you are, or how you access the Library, the experience will be seamless.
  • Space: Take a leadership role in campus space planning for education. Invite partners to work with us to re-envision library space. Design exceptional services across all our campuses in traditional and new library spaces. Plan for nearly complete digitization, transfer, and/or deaccession of non-unique print collections.
  • Funding: Significantly increase grant applications and donor relations to pursue new resources for library programs, services, and collections. Increase UCSF partner funding.

To activate these objectives the Library is initiating five interconnected focal projects to maximize cohesion of services and collaboration among staff. In conjunction, each of these projects is major step toward sustaining the future of the Library.

Project: Patient-Centered Service
Vision: Empower UCSF patients and the community to engage with their health.

The Library will empower patients and their families to be a central part of their health care and research teams. It will foster a culture of patient engagement by facilitating patient-facing technology, curating collections of patient education materials, advocating for increased patient access to information, and teaching digital and health literacy skills. It will also provide world-class spaces for patients and their families to learn, form communities, and engage with their health.

Project: Education and Technology Core
Vision: Lead UCSF’s strategic initiatives to advance education technology.

Educational technology at UCSF has become critical to achieving campus-wide educational goals. The Education and Technology Core will provide the systems and services to meet these needs. The Core will create opportunities for our education community to work collaboratively, share knowledge, and explore new technologies. It will work with academic programs to evaluate and deploy new tools and integrate essential tools for maximum benefit to learners. Educators will engage a team of technical experts, instructional designers, and media experts to plan their technology enhanced learning projects.

Project: Learn with the Library
Vision: Center the Library as a platform for open education and science for all of UCSF.

Through Learn with the Library, the Library is being re-envisioned as a platform for collaborative open science education. Building on our educational programs, it will bring together content experts from across the Library to redesign and realign our classes, workshops, and consultations in order to foster a culture of open learning and scholarship. It will also identify new partners interested in working with us to expand the educational offerings available through the Library, and will investigate new modes of training to ensure that everyone at UCSF has access to education that is tailored to their needs.

Project: A UCSF Online, Open Lending Library
Vision: Make the Library collection universally accessible by digitizing the collections.

As UCSF is becoming more geographically dispersed, the Library recognizes the importance of making its collections universally accessible in an online environment. It will digitize portions of our print circulating collection as well as collections from the Archives to meet the educational and research needs of students, faculty, staff, and the public. Online access to these collections will enhance their collaboration and expand accessibility. Digital collections will enable the Library to reach its goal of serving the needs of the UCSF community wherever they are located.

Project: Transforming Service at the Library
Vision: Elevate the patron experience at the Parnassus Library through excellent service.

Starting with the Parnassus Library, the main floor will be re-designed to significantly improve the patron experience. A single service point will be created where Library service staff are visible, approachable, and versatile in their skillsets and knowledge bases. By placing services just inside the main entrance and adjacent to the natural gathering space of the Living Room on the main floor, patrons will be able to engage in a wide variety of learning activities. This will encourage serendipitous interactions to spark collaboration by inviting faculty, staff, and students to engage across disciplines.

“Without libraries what have we? We have no past and no future.” – Ray Bradbury

Kudos to Chris and his team for envisioning a very promising future…

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Dan’s Tip of the Month

Music is more than entertainment to me. Whether instrumentals or vocals, it brings solace, joy, inspiration, and sometimes even sadness. Last month the world lost an artist who was able to evoke all of these emotions – Aretha Franklin, the Queen of Soul. Spend some time with her music and share it with a young person in your life. This Kennedy Center tribute is a great place to start, and this online collection will allow you to completely indulge in her amazing talents.

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