The COVID-19 pandemic has emerged as the public health challenge of our time, with more than 15 million confirmed COVID-19 cases and over 550,000 deaths in the United States (as of April 2021). Moreover, the disease has exposed profound disparities in different ethnic and racial groups across the US, with non-Hispanic Black persons and Hispanic or Latino persons being hospitalized at 4.7 and 4.6 times the rate of non-Hispanic White persons, respectively. Immigrant communities have been disproportionately affected, often because of exposure in the workplace settings, compounded by more dense housing and limited access to information and medical care. In San Francisco over 80% of the cases have been concentrated within four zip codes. This disproportionate impact on persons of colors demands action towards creating permanent structures to protect our most vulnerable and ensure this type of disproportionality never happens again. Responding to the need to address the profound health disparities that have undermined epidemic control, COVID-19 also demands an approach that begins with engaging communities to ensure strategies address the root causes of inequities, while also leveraging data and other technological innovation to monitor and control the spread of disease. Developing these strategies that are tailored to the unique local needs is critical to responding effectively to limit the spread of infectious disease outbreaks, address the health inequities brought to bear by the pandemic, reduce human suffering and the loss of human life and pave the way for more inclusive models of community-led care.While the COVID-19 situation in San Francisco was grim at the height of the pandemic it still had the lowest death rate of any major metropolitan area in the United States. This relative success is due in part to the San Francisco Department of Public Health?s commitment to community programs that were built up to address the HIV epidemic. Because o
f existing partnerships SFDPH and UCSF were able to quickly form a coalition of community partners uniquely positioned to successfully design and implement tailored COVID-19 testing initiatives in communities with high transmission rates and at high risk for severe disease. We propose to strengthen the public health system by expanding and strengthening the network of community programs, addressing whole person health, routinizing bi-directional communication and learning from communities, creating an enabling environment for community programs to succeed, promoting data to address inequities, disseminating and adapting guidelines and best practices, training a diverse workforce support community health, integrate existing health programs and data systems, and evaluating programs and implementing continuous quality improvement. SFDPH has long standing relationships and networks with the community-based organizations in San Francisco and UCSF. This partnership is uniquely equipped to address the three strategies by leveraging the assets and experience of each of the partners. This a collection of long-standing partnerships that have worked together to address every public health crisis in the last 40 years and is ready to take on health inequities in San Francisco. These partners mobilized quickly during the pandemic implementing proven strategies and pioneering new ones to mitigate the effects of COVID-19. This partnership coalesced around erasing health inequities in San Francisco can serve as a model for the rest of the country by innovating, implementing, studying and changing policy as these partners have done during the HIV epidemic in San Francisco.
