San Francisco’s Soda Tax funded efforts hold the potential to change the health status of community members most burdened by chronic diseases and the environments in which their health is shaped. Thus, much of the work focuses on changing policies, systems, and environments to address social determinants of health, including reducing barriers to housing, healthy food and beverages, education, safe neighborhoods and environments, employment, healthcare, etc. To that end, San Francisco’s Department of Public Health (SFDPH) and Human Services Agency (SFHSA) have partnered up to increase knowledge of public benefits such as CalFresh, Medi-Cal, CalWORKs and County Adult Assistance Program/General Assistance (CAAP/GA). Soda Tax-funded organizations attended a training last year about how individuals can qualify for the various public benefits available in San Francisco. Some organizations also trained their staff to submit benefits applications on their clients’ behalf via an online application portal. Continuing in the partnership, guest blogger, Makena Nakaji, SFHSA Communications Intern, provides an update on the recent Medi-Cal Expansion.
By Makena Nakaji, SFHSA Communications Team Intern
More than 250,000 San Franciscans rely on Medi-Cal to receive access to healthcare benefits. Medi-Cal provides eligible individuals and families free or low-cost medical visits, hospital care, prescription drugs, pregnancy-related treatment, dental coverage, and other medical services. This program has allowed many Californians with limited income and resources to access a wide variety of healthcare services they would not otherwise have.
As of January 1, 2024, there have been two major updates to the eligibility guidelines for Medi-Cal. With these expansions to the program, more Californians will be able to receive financial support for healthcare services. Being able to reach more people with these services will help combat health disparities as the state of California is working toward breaking financial barriers in healthcare. Undocumented Californians aged 26-49 will be able to get full Medi-Cal, regardless of immigration status. This ensures that those eligible will receive access to affordable healthcare. All other Medi-Cal eligibility rules, including income limits, will still apply. Those who receive restricted scope Medi-Cal (also known as limited Medi-Cal or emergency Medi-Cal) will automatically get full Medi-Cal. These expansions are huge improvements to the Medi-Cal system and creates a more inclusive community for those who need support. Healthcare shouldn’t be the reason a family struggles to make ends meet, which is why this change will help so many more people.
Restricted scope Medi-Cal recipients should check their mail in the coming months for more information about their new added benefits.
If any Medi-Cal recipients have moved in the last three years, please encourage them to update their address with SFHSA.
The second change to the eligibility is that asset limits are ending. Even if someone has rental properties, a second home, retirement funds, or savings, Medi-Cal may be available to them.
Lots of changes have been made, but to make it easier, people can use BenefitsCal.com to easily check to see if they qualify for benefits, apply for benefits, upload case documents, and maintain their Medi-Cal and other benefits! Community Based Organizations (CBOs) that help clients apply for benefits can also create a CBO account on BenefitsCal.com.
Centering youth empowerment: a celebration of 5 Years of SF soda tax in partnership with Urban Sprouts and June Jordan School for Equity
As a new member of the Healthy Eating Active Living (HEAL) team, I was thrilled to apply my background in youth engagement to help put on a special youth event in celebration of the 5-year anniversary of the SF soda tax.
Since the soda industry spends an exorbitant amount of money tailoring their marketing to young people, we thought it important to highlight the multiple ways the soda tax revenue benefits young people and counters these effects. Not only are young people themselves particularly attuned to these tactics, they are also powerful agents of change in their communities. So, it was a great honor to partner with the Sprout Out youth apprentices from Urban Sprouts internship program to plan and lead this lunchtime event at June Jordan High School for Equity in celebration of the 5-year anniversary of the San Francisco Soda Tax.
To kick off the celebration, Dr. Susan Philip (SF Department of Public Health) addressed the students over the loud- speaker, welcoming them to the event and sharing a bit about the soda tax. Dr. Philip also identified some ways the San Francisco Unified School District (SFUSD) directly benefits from the soda tax revenue, which includes the installation of hydration stations, upgraded kitchen infrastructure, school-based oral health screenings and sealants, student run programs like Sprout Out, and the implementation of SFUSD wellness policy.
Once the bell rang, the students gathered in the garden to participate in engaging sugar education activities led by the Urban Sprouts youth apprentices. The student-led activity booths included:
A sugar jar guessing game, where the students could visualize and guess how many sugar cubes (or teaspoons) of added sugar an average American consumes in a month- a whooping 527!
A Sugar line up activity where the students had the chance to guess from highest to lowest, how many teaspoons of added sugar they thought were in some popular store-bought drinks
A smoothie bike demonstration where the students could ride a bike and blend a banana date smoothie
A water tasting station with water infused with fresh herbs from the garden
In addition to these student- lead booths, SFUSD student nutrition services (SNS) and Revolution Foods joined us to offer free lunch samples and the June Jordan wellness center shared some resources. Once the students visited all the booths, they were entered into a raffle for the chance to win a gift card. Ultimately, 3 students won a gift card from the raffle and one student won the sugar jar game with a guess of 550 sugar cubes! Overall, the event was a great success with smiling faces and around 50 students in attendance.
It was a pleasure to see the June Jordan students so engaged in the activities and the Urban Sprout apprentices shine in their leadership roles. In Principal Chui’s words, “It’s always uplifting to see visitors be uplifted by our own students. A beautiful and educational event for our school community! A special thank you to SFDPH and SFUSD SNS for facilitating an engaging event.“
Thank you to Urban Sprouts and June Jordan School for Equity for a fun event!
San Francisco Sugary Drinks Distributor Tax Advisory Committee’s commitment to providing community-driven and evidence-based recommendations to advance healthy and equitable communities
The recently published article by the San Francisco Bay Area Planning and Urban Research Association (SPUR), Revenue Allocations from Soda Taxes in Oakland and San Francisco Continue to Diverge from Advisory Committee’s Recommendations, highlighted the considerable amount of time and effort spent by members of the San Francisco Sugary Drinks Distributor Tax Advisory Committee (SDDTAC) as well as the discrepancies between the the SDDTAC’s budget recommendations and Mayor’s budget allocations. Although the allocations diverge from the recommendations, San Francisco’s SDDTAC remains committed to making community-driven funding recommendations which support services and other innovative, community-led work to decrease the consumption of sugary beverages, increase access to water, and support healthy eating and active living.
The general purpose of the SDDTAC is to make funding recommendations to the Mayor and the Board of Supervisors to reduce the consumption of sugary drinks in San Francisco and evaluate the impact of the revenue allocation from the soda tax. The San Francisco Sugary Drinks Distributor Tax (SDDT) Ordinance and the Sugary Drinks Distributor Tax Advisory Committee took effect on January 1, 2018, and over the last five years, the 16-member SDDTAC committed more than 900 hours per year to discuss budget recommendations, evaluate programs, receive input from the community, and communicate those priorities by submitting a balanced budget based on the amount allotted by the SDDT. A recent prospective longitudinal study reported a 34% decrease in average sugar-sweetened beverage consumption following the first two years of tax implementation1. Findings from the comprehensive evaluation report show that (1) the San Francisco SDDT Ordinance and SDDTAC have been identified as effective in addressing health disparities resulting from the consumption of sugar-sweetened beverages as well as addressing long-standing inequities; (2) The SDDT values have ensured that SDDT funded programs focus on and effectively engage communities most burdened by inequities; (3) Organizations and agencies used SDDT funding to help those communities experiencing the worst health and economic impacts of the COVID-19 pandemic meet basic needs while simultaneously supporting the structural changes necessary to promote equity; and (4) SDDT funded entities are beginning to achieve desired outcomes. The last five years have provided San Francisco communities with access to programs and activities that aim to support community-led and culturally relevant work, build strong collaborations and partnerships to increase capacity and effectiveness, eliminate structural inequities and achieve equity, and result in long-term impacts.
Additional SDDT-funded highlights from FY 2021-2022 include:
More than 49,850 individuals participated in SDDT-funded grant programs
24,132 (46% of SFUSD students) benefited from SDDT-funded structural changes such as Refresh kitchens and/or SDDT hydration stations
SFUSD Student Nutrition Services provided more than 7.5 million meals to SFUSD families
10,356 toothbrushes were distributed to SFUSD students
2,188 community members received Requity scholarships
13,923 individuals received Market Match incentives/supplements
4,417 individuals received Vouchers4Veggies
We invite you to join us in celebrating San Francisco’s 5-year soda tax by attending any of the upcoming events below.
Florence Fang Community Farm 41 Diana St. San Francisco 94124
The celebrations will kick off with a family-friendly event at Florence Fang Community Farm on November 4th. The community will gather to celebrate and enjoy healthy, delicious foods and family-friendly activities and entertainment provided by organizations that have been funded by San Francisco’s soda tax.
From Political Campaign to Policy Implementation and Beyond: Join a virtual panel of experts who were instrumental in passing not just the soda tax, but other policies that support healthy eating, active living, and equitable access to water, and discuss the future of soda taxes in the Bay Area and beyond.
The Sugary Drinks Distributor Tax Advisory Committee is dedicated to serving the San Francisco communities to improve their health and wellbeing. The committee cannot do this work alone and values your input. If you have more questions or feedback about our recommendations and/or the Mayor’s budget, we encourage you to attend our monthly SDDTAC meetings by joining through Zoom or calling in. In addition, you can let the Board of Supervisor of your impacted district know what is important to you, and can contact the Mayor’s Office about your priorities and how they impact the work you do and the community you live in. We invite you to view the links below and we hope to see you at our monthly meetings. Lastly, we would like to acknowledge and recognize our partner in advocacy, SPUR, for uplifting the work of the San Francisco Sugary Drinks Distributor Tax Advisory Committee.
2023 Data Report (report will be posted to www.sf.gov/sddtac in November 2023)
1 Silver LD, Padon AA, Li L, Simard BJ, Greenfield TK (2023) Changes in sugar-sweetened beverage consumption in the first two years (2018 – 2020) of San Francisco’s tax: A prospective longitudinal study. PLOS Glob Public Health 3(1): e0001219. https://doi.org/10.1371/journal.pgph.0001219
The Sugar & Decoloniality Series by Dr. Amber McZeal
Guest blog post by Nasser Albaqqal and videos by Elijah Roberts with Bounce Back Generation. The Sugar and Decoloniality 2.0 series was made possible with funding from the San Francisco Sugary Drinks Distributor Tax. The San Francisco Department of Public Health and Shape Up SF Coalition have utilized the resources generated by the SDDT to bring attention to the complex relationship between sugar, colonialism, and its impact on social, economic, and physical health.
Who doesn’t want a little bit of sweetness in life? Sugary foods and drinks are consumed every day as treats and as a hidden ingredient in processed foods, part of our Standard American Diet (SAD). It started in the 16th century when humans began to increase how much they used sugar. Over the hundreds of years since then, sugar has been hiding some dark secrets, namely its role in the Atlantic slave trade.
For approximately 400 years, millions of enslaved Africans were transported to the Caribbean, South America, and later the United States to work on massive sugar plantations.These plantations generated significant wealth for European colonial powers and their colonists. The term “coloniality” originates from this system that enslaved many, enriched others, and shaped the way the world looks (and eats) today.
The Shape Up SF Coalition and San Francisco Department of Public Health’s Healthy Eating Active Living (HEAL) Team wanted to highlight this connection between the ways sugar has affected us socially, economically, and our physical health. Dr. Amber McZeal is an expert in “Decolonizing the Psyche”. Her Sugar & Decoloniality series helps to reveal how colonization has seeped into so much of our lives today, influencing systems and practices that we take for granted, and becoming embedded in our psyche. We must “decolonize”, peeling back layers of messaging, history, and harms to expose the truth about ourselves as individuals and the traditions and cultures we come from that have been suppressed through centuries of colonization practices.
Bounce Back Generation’s Elijah Roberts participated in the series. The video diaries he shares below reveal how he learned about coloniality during Dr. McZeal’s 4-part series held in San Francisco from April to September 2023. As you will see, the series had a profound impact on him intellectually and emotionally. Learning about decoloniality revealed his connection to his own past and to the cultures and nature we all need to connect and reconnect with. Below is a short description and video of each section.
Coloniality and Sugar (Session 1)
Why look at the sugar industry? Dr. McZeal reveals how the legacy of colonialism, enslavement, and oppression continues to shape sugar production and consumption. Most of today’s sugar comes from lower-income countries where exploitation and economic inequality is all too common. We know the health effects of sugar (diabetes, heart disease, and high blood pressure) affect lower income, and people of color much more frequently. Sugar plays a key role in colonialism, a profoundly brutal phenomenon that continues to damage already marginalized people through the promotion of unhealthy foods. In this video, Elijah talks about recognizing the historical and continuing injustice of the industry.
Decolonizing our Heritage: The Impact of Coloniality and Capitalism (Session 2)
In Session 2, Dr. McZeal explores how colonialism and capitalism have hijacked heritage and culture. We may ask ourselves about our own heritage – what language do you speak, what food do you eat? How much of this has been taken, stolen, or commodified by capitalism? Decoloniality is the act of questioning our knowledge, reframing our thought and taking back ownership of our heritage. Dr. McZeal explains that this process helps us rebuild our connections with indigenous knowledge, our own histories, and each other. In this video, Elijah looks at how capitalism separates us from our culture, heritage, nature, and even our own psyche.
Taking Back Earth: The Impact of Coloniality and Capitalism (Session 3)
Session 3 highlights how colonial industries exploit both people and resources, causing damage to the planet. Dr. McZeal emphasizes the need to appreciate and protect the natural world, acknowledging that humans are a part of it, not its owners. Session 3 focuses on reconnecting with nature and reflecting upon our connection to the planet. In the video below, Elijah reflects on his experience as he is guided through Dr. McZeal’s meditative peace walk around the gardens of San Francisco’s Presidio Tunnel Tops. This exercise serves as an example of how changing our perspectives can affect systems at large. Elijah’s realization of the power of his own personal connection and need for nature demonstrates that we are both a part of the Earth, and it is part of us. As we rebond with the planet, we can influence its health and in doing so influence and improve our own health.
Reflections and Celebrations of Our Coloniality Series (Session 4)
From the exploitative past and present to taking back the pieces of our lives that we lost to coloniality, this final chapter celebrates our journey so far.
We would like to thank Dr. Amber McZeal, the San Francisco Department of Public Health’s HEAL Team, and Shape Up San Francisco for their dedication and effort in creating the sessions and blog series.
Elijah gained so many insights that he shared below and in his final video.
As we gathered to celebrate, I remembered the knowledge and teachings from each session. We must carry this knowledge with us daily and use it to empower ourselves and our communities.
In session 1, we learned about how we have been wronged by an exploitative system. This knowledge is crucial in understanding the root causes of our struggles and in continuing to fight for justice and equity.
In session 2, we were reminded to never forget our culture and heritage. This is a powerful message that encourages us to embrace our identities and take pride in who we are. As we continue to reclaim and celebrate our culture, we are also breaking down the colonial mindset that has been forced upon us.
In session 3, we learned about the importance of the earth in our daily lives. Let us never forget that we are all connected to the planet, and our actions have a direct impact on its health. By being mindful of our environment and our relationship with it, we can work towards creating a more sustainable and harmonious world.
In session 4 – We remember that our journey is far from over. Our communities are continuously fighting against systemic oppression and injustice. By coming together and reclaiming the pieces of our lives that we lost to coloniality, we are taking powerful steps toward healing and liberation.
Remember how you have been wronged by colonialism and use that knowledge to fuel your passion for justice. Never forget your culture and heritage, and always find ways to celebrate and honor them. Above all, remember that the earth is an integral part of our lives and protect it with all your might. Together, we can continue to break down the effects of coloniality and build a better, more equitable future for all.
Guest blogger, Ellen Garcia, Program Manager of EatSF-Vouchers 4 Veggies, shares how the SDDT-funded program is leading the movement to integrate nutrition interventions into healthcare.
By Ellen Garcia, Program Manager, EatSF-Vouchers 4 Veggies
EatSF-Vouchers 4 Veggies is an innovative, community-based food voucher program founded in 2015. It began as a project of UCSF physician-scholar Dr. Hilary Seligman, who was interested in the relationship between food insecurity and chronic diet-sensitive conditions like diabetes and hypertension. She suspected many low-income patients at San Francisco Hospital were unable to afford the fruits and vegetables recommended by their doctors, and that simply providing means to buy these foods could improve their symptoms. She decided to study the impact of providing produce vouchers, redeemable at nearby stores, on such patients. Her theory proved right, and Vouchers 4 Veggies was born.
Vouchers 4 Veggies does not generally work directly with patients or program participants; rather, we partner with clinics and community-based organizations to distribute vouchers to their own clients. Eligibility is determined by the clinic or organization, depending on need and/or health status. Participants receive $10 a week or more in fruit & vegetable vouchers for several months. Vouchers can be redeemed at over 40 San Francisco food vendors including farmers’ markets, corner stores, small specialty markets, and large grocery chains, allowing participants to choose where to shop, when to shop, what fruits & vegetables to buy, and how much to buy at once. The result is an extremely flexible health intervention that meets participants where they’re at and supports providers in engaging people around their most basic needs. What’s more, this model supports small food businesses and keeps dollars in the community. In fiscal year 22-23 alone, Vouchers 4 Veggies produce vouchers drove nearly a million dollars in fruit & vegetable purchases in San Francisco— over a third of which were made at farmers’ markets and BIPOC-owned small businesses.
A mere 8 years after Vouchers 4 Veggies was founded, public awareness of food insecurity – especially in the health professions – has changed dramatically. The idea that diet and disease are interconnected is not new, nor is the idea that food insecurity (having unreliable access to food) has health consequences. But we’re reaching a new understanding of health impacts from what’s come to be known as “nutrition insecurity”: having unreliable access to nutritious food. This idea has coalesced healthcare providers and food assistance programs around America into the Food As Medicine movement, which seeks to integrate nutrition interventions into healthcare and vice versa. It’s also become such an area of interest that it was a key topic at President Biden’s 2022 White House Conference on Hunger, Nutrition, and Health. Healthcare providers all over the country are now launching “produce prescription programs” but Vouchers 4 Veggies, with years of experience in San Francisco and program pilots across the country, has become a leader in the space by keeping its model simple and continually researching and refining for impact.
Vouchers 4 Veggies’ ongoing evaluation and research informs both program improvement and “nutrition security” advocacy at the city, state, and federal level. This research shows Vouchers 4 Veggies program participants consume more fruits and vegetables not only while receiving the vouchers, but also continue that consumption and behavior after their enrollment ends. Participants report feeling more comfortable trying new fruits & vegetables because of the vouchers, ultimately incorporating them into their meals and shopping patterns. And results are especially impressive for low-income pregnant people, served by Vouchers 4 Veggies in partnership with San Francisco WIC and other local clinics; one study of pregnant voucher recipients showed a 37% reduction in the odds of preterm birth!
Given that San Francisco’s preterm birth rate is higher than the state’s average, at 8.6%, such a reduction in preterm births illustrates how a simple intervention like produce vouchers can go a long way toward improving health equity. These results also show why Vouchers 4 Veggies believes produce prescriptions should be included in the medical care people receive. And working with healthcare partners throughout San Francisco and the state, we hope to make this a reality in the near future.
