San Francisco makes the healthy choice the easy choice

San Francisco makes the healthy choice the easy choice

In 2015, the university removed all sugar-sweetened beverages from every store, cafeteria, food truck and restaurant on its sprawling campuses. And the city of San Francisco is poised to become the first in the U.S. to rid all its hospitals of the drinks that researchers believe feed national epidemics of obesity and diabetes.

Both efforts are part of a unique collaboration between public health officials and advocates, academic researchers and community coalitions described in a new report in Preventing Chronic Disease, a publication of the Centers for Disease Control and Prevention.

Dubbed the San Francisco Health Improvement Partnership, the collaboration has improved public health in the city of 850,000 in three ways: it reduced consumption of sugar-sweetened beverages; it restricted retail alcohol sales; and it provided dental care to previously undeserved children.

The partnership stole a page from the anti-smoking playbook in its attack on soda, said lead author Dr. Kevin Grumbach, who chairs the department of family and community medicine at the University of California, San Francisco (UCSF).

“We need to apply the lessons of tobacco control to other health conditions,” he said in a phone interview. “The biggest impact was through taxes and environmental restrictions on smoking.”

In addition to getting hospitals and hospital food vendors to stop serving soda, the partnership helped enact a voter-approved tax on sugar-sweetened beverages in San Francisco last year.

It also helped stop Starbucks and Taco Bell from receiving liquor licenses in San Francisco, helped prevent state authorization of powdered alcohol and worked to increase the number of medical clinics painting cavity-preventing fluoride varnish onto children’s teeth during routine well-child visits.

“When you get people to get out of their silos and work together, you can really make a difference in the conditions that create healthy communities,” Grumbach said.

Listening to residents of low-income communities proved vital for selling them on the benefits of taxing sugary beverages, Grumbach said. He experienced an “aha” moment when a member of a community group suggested that free water-filling stations she’d seen near yoga studios should be brought into her neighborhood, where lower-income residents tended to quench their thirst with soda.

“It’s making the healthy choice the easy choice,” Grumbach said.

Nutrition epidemiologist Barry Popkin, a professor at the University of North Carolina at Chapel Hill, applauded the effort of the San Francisco partnership.

“This is the kind of change we need at the national, state and local level if we’re going to remove some of the major health disparities,” he said in a phone interview.

“It’s the direction of the future if we’re going to truly impact the diets of the poor in any meaningful way,” said Popkin, who was not involved in the new study.

Grumbach’s coauthor Laura Schmidt said that after research from UCSF repeatedly exposed public health harms associated with soda, their colleagues felt compelled to act.

“We just felt as an institution that the right thing to do was to get out of the business of selling sugary beverages or profiting from them,” Schmidt, a sociology and public health professor at the School of Medicine, said in a phone interview.

“We ought to model a healthy food environment,” she said. “If we don’t do it, who will?”

Low-income hospital workers appear to be the biggest beneficiaries of the hospital soda ban, Schmidt said.

In a separate, as-yet unpublished study, researchers followed 2,500 of the medical center’s 24,000 employees. The lowest-paid workers - janitors, cafeteria workers and shuttle drivers - drank on average 30 ounces a day of sugary beverages before the ban, while professors drank on average about 4 ounces a day, Schmidt said.

Six months after the ban took effect, she said, the lowest-wage workers were drinking 25 percent less soda.

All University of California campuses now are considering banning soda, and the San Francisco campus is considering health interventions seen at other campuses, like signs at elevators on the Los Angeles campus pointing to stairwells - a cardio-healthy, calorie-reducing way of ascending and descending.

“We learned something from the tobacco debates. Physicians used to smoke at the bedside in hospitals. The candy striper would sell you cigarettes,” Schmidt said. “Some day our children will look back and say, ‘You were giving people soda in bed when they were sick in the hospital?’”

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