Chancellor’s 2018 State of the University Address
25
August

By Adem Lewis / in , , , , , , , , , , /


(piano music) (people talking) – Hello, everyone. Please take a seat. Thank you for coming. It’s my pleasure to welcome you to the 2018 State of
the University address. My name is Lisa Cisneros. I’m a senior director
in University Relations. Now would be a good time
to silence your phones. Today we’re here to
celebrate our community. I want to tell you that
it’s being live streamed on YouTube, and this event
is being photographed. Welcome to everyone. It is my sincere pleasure to welcome our chancellor, Sam Hawgood. (audience applauds) – So good afternoon, everyone, and welcome and thank you for joining
us here in Cole Hall, for those of you who are
gathering at Mission Bay, Mount Zion, Zuckerberg San
Francisco General Hospital, and those in Oakland and Fresno, and those of you who are
watching as live stream. Now as we gather together here today, the first funerals are
occurring in Pittsburgh for the victims of the
anti-Semitic attacks that occurred at a
synagogue there on Saturday. And only a few days prior,
two African Americans were killed in Kentucky in what is also being investigated as a hate crime. I don’t need to tell you
that these repeated acts of violence, all too
common in our country, driven by fear and hatred
of our differences, whether they are differences of faith, race, political beliefs,
sexual orientation or others, are truly soul destroying. The pain and sorrow, of course, first hit the communities that
are directly involved, but an attack on one
community is an attack on all. I want to acknowledge the pain and sorrow and outrage that many
of you here feel today and when any of these
heinous events occur. Now caring and healing are two words in our mission statement. We generally take them to mean our work with one patient and one family at a time. But caring and healing can also be caring for our own family here at UCSF and the communities we serve. I’d like us to remember that as we talk, through the talk here today. Now it is my privilege
to deliver our annual State of the University address. This address is a time for me to express the gratitude that I have to all of you for your efforts to advance
our collective goals. I also wanna thank my leadership team, many of whom are here
today, for their counsel and contributions throughout the year for what has been, in truth, an amazing year for UCSF. Our success is a direct result of your dedication and passion. These efforts have been very fruitful in the last year. I’m pleased to say that in 2018, the state of our university is strong. By many measures, our ranking among the nation’s top hospitals,
the grants awarded for our scientific research,
the quality of our learners and our firm financial footing puts UCSF as one of the premier health science universities in the world. In my address today, I would like to accomplish two things. First, I’ll share some
highlights from the past year. Secondly, I will reflect on our connection to the communities of which we are a part. Our responsibility to address the needs of these communities
in ways that go beyond our traditional core missions of learning, caring, healing and discovery. It is my hope that the stories we share with you today will motivate each of us to take action, to get
involved in new ways in our communities where we work and live. Let me begin with a few
of the recent highlights that are a credit to what you, our university community, do to advance health worldwide. There’s no question that we are living in an incredibly exciting
time in health and science. Fantastic new tools in both the physical and life sciences are enabling us to better understand,
treat and prevent disease like never before. Let me just give two
examples from the past year. Our researchers are using a rapid and flexible approach, employing CRISPR gene editing technology to alter, enhance and reprogram T-cells, a very important circulating immune cell, to give them the specificity
to destroy cancer, recognize chronic infection or treat autoimmune
disease, amongst others. We expect that this technique will be widely adopted in the coming years in the burgeoning fields
of synthetic biology and cell therapy,
accelerating the development of new and safer treatments for currently life-threatening or disabling diseases. In addition to their basic research, we are collaborating across a wide front of clinical trials. I’d like to highlight just one, and that is our attempts to find a cure for sickle cell disease,
a debilitating condition affecting millions around the world. This video that I’d like to now introduce will give you a better understanding of how our physician scientists at UCSF Benioff Children’s
Hospital Oakland are treating one young patient. – [Jazz] I’m a fairy. I’m a pirate. I’m a princess. – [Jan] When she was three, I was directing a play, and she stepped on the stage all by herself. It gives her a lotta
joy, and she doesn’t have to focus on the hurt and the pain. She can smile. – When someone looks at me, they wouldn’t know anything was wrong. Because of their shape, sickle cells don’t live as long as
normal red blood cells do. – We got the diagnosis that Jazz had sickle cell SS. We were informed that she would only have a life expectancy of about 25. I did not accept that
she had a life sentence. I got custody of Jazz when she was three, and I became not only her grandmother who was raising her, but
her full-time caregiver. When the pain hits with the sickle cell, it is excruciating. – [Jazz] It feels like something is just, like, stabbing me. Sometimes I feel like I can’t move. – What I wasn’t prepared for was the pain that we have to endure when she’s suffering because you can’t make it go away. I chose UCSF Children’s
Hospital here in Oakland because they have the
best sickle cell program in the world. The nurses and the doctors,
everybody that touches your child, they really treat the children like they care about them. Makes a big difference
because she’s not scared. – Dr. Marsh is, like, one
of my favorite doctors. She’s always very nice, and she always comes to see all of my
productions that I’m in. – I was never trained to be a caregiver. I felt alone. But UCSF has given me the tools I needed to take care of my
granddaughter as best we can. My hope and my prayer for Jazz’s future is that she beats this thing. She’s gonna be a survivor. – When I grow up, I used
to just wanna be an artist. Now I wanna be a doctor and an artist. (audience applauds) – Work like this reflects
why our researchers received almost $600 million in biomedical research funding from the National Institutes
of Health last year, more than any other public institution. In other great recent
news, UCSF Medical Center has once again been recognized as the number one hospital in California, and amongst the finest
hospitals nationwide. In recognition of the compassion and excellence of care from our clinicians and staff, our medical center was named as the best hospital in California for cancer treatment, and
was ranked third nationwide and best in the West for
neurology and neurosurgery. This year, we’ve also continued to innovate in education. The School of Pharmacy has introduced an exciting new PharmD degree curriculum that further emphasizes science as its distinguishing strength, but it has done that in addition to reducing the time to degree by 25%. This three-year curriculum
prepares students with a scientific mindset
and gives them training from day one as clinicians
and critical thinkers who seek to improve systems, policies and practices. Our School of Nursing began its Doctor of Nursing Practice
program this spring. This online program
prepares clinical experts and leaders to apply theoretical
scientific principles to advance nursing practice. This new program is a critical part of our effort to increase the number of doctorally prepared nurses who can meet the complex needs of our patients. Both of these innovations in education underscore the excellence and leadership in our schools of nursing and pharmacy. Now our students have, for years, rotated to sites in Fresno
and the Central Valley, but this year, we became
a formal branch campus of the UCSF School of Medicine. This allows us to lead the San Joaquin Valley PRIME program in medical education, a training program designed to address the
unique health programs, the health needs of the Central Valley and the underserved
populations that are there, including the critical physician shortage in the region. Our graduate division at UCSF joined eight other institutions to found the Coalition for Next
Generation Life Sciences to give Ph.D students and
postdoctoral researchers clear standardized data on
graduate school admissions, time in training and career outcomes. This is an important
and long overdue effort to increase transparency around graduate and postgraduate education. I thank very much Dean Liz Watkins for her exceptional national leadership. We also remain committed to exploring and being part of the solutions to the planet’s climate crisis. Unquestionably, climate
change is directly linked to public health. UCSF’s Institute for
Global Health Sciences recently convened an
important international forum to connect climate change with changes in global health. I look forward to the followup from this very important meeting. UCSF and the entire UC
system is working towards the goal of carbon neutrality by 2025. Our portfolio of projects this year to drive towards that goal includes 1.8 megawatts of solar panels at six UCSF sites to be completed by the end of this year. We are also rolling out
15 new all-eclectic buses to replace gasoline and
diesel-powered shuttles. This alone will remove 60 metric tons of carbon dioxide from the air per year, and help improve air
quality in our community. One of the greatest challenges that we have faced in the last year is the continuing rising cost of living in the San Francisco Bay Area. This is especially true for those raising young children. I’m pleased to announce that this summer, we opened the largest childcare facility in San Francisco. The University Childcare
Center at Mission Bay can serve more than 270 children daily, aged from two months to five years. The opening of this center nearly doubles our childcare capacity,
allowing more faculty, staff and trainees to balance personal and professional commitments. Now as I mentioned at
the outset of my address, UCSF is well positioned financially to support our mission-critical work. For the fiscal year ending in June, total revenues increased nearly 70% to just over $7 billion per year, compared to $4 billion
just five years ago. As a result of the robust demand for our clinical services, UCSF Health Systems’ net patient revenues grew by more than 10% from the previous year to be now more than $4 billion. During this time, UCSF provided more than $380 million a year in undercompensated care, including care for uninsured patients and underreimbursed care
for the Medi-Cal patients that we serve. I’m proud to say that UCSF continues to be the number one
provider of hospital care to Medi-Cal patients, amongst all San Francisco hospitals. Our contracts and grants, which fuel our discovery mission, now account for $1.4 billion of revenue per year, a 6% increase over last year. These research awards are
the second largest component, or 30%, of our overall revenue pie. As you know, last year at this event, I launched UCSF: The Campaign, our first comprehensive
fundraising campaign in more than a decade, designed to help us sustain UCSF’s excellence and build for its future. I’m delighted to share today that this was a record-breaking year. Counting gifts, grants and pledges, we raised over $1.2 billion. As a result, we are one of only a very small handful of universities that have reached the $1 billion threshold in a single year. Since beginning the quiet
phase of the campaign in 2014, we have now raised nearly $4.2 billion towards our $5 billion fundraising goal. During this period, we
have received more than 185,000 campaign gifts from nearly 113,000 individual donors. Importantly, 70,000 of those donors are new to UCSF and our missions. Now while this success
underscores the scale of the bold ideas that
are inspiring our donors, it also tells the story
about our UCSF community. More and more faculty members have been approaching me, not as individuals with their own needs, but rather as teams with a well-thought-out
collaborative vision about how they plan to work together to tackle even larger,
more complex problems. Threading throughout our campaign goal is the importance of sustaining support for our students and our faculty, the drivers of our future. I’m pleased that during
the campaign so far, we have already raised
more than a billion dollars for endowment for our
faculty and students, more funding than any
other area of the campaign. Some of this support comes in the form of pledges paid in the years ahead, but our strong focus on
endowment will allow us to compete head to head
with private institutions with much longer
histories of raising money for faculty and student support. One gift that has come in recently that I am particularly proud of was made by an alumna of our Ph.D program. That donation was an
inaugural campaign gift for women in discovery science, providing funds to support recruitment and retention of women in basic science. Now a year ago, again, at this address, I pledged to begin the
planning to revitalize the facilities of our
Parnassus Heights campus. I’m proud to say that earlier this year, we announced a truly remarkable $500 million commitment from the Helen Diller Foundation
to support the planning, design and construction of a new world-class hospital here
on Parnassus Heights. This gift ensures that we will be able to continue to provide premier care to patients in the San Francisco Bay Area and beyond, and it allows us to begin the extensive planning process for an architecturally outstanding,
patient-centered and environmentally sustainable hospital. The preliminary timeline
that we are working on calls for construction to begin in the second half of 2023, and for the hospital to be opened before 2030. As always, the world-class
medical treatment at all of our campus is driven by cutting-edge discovery. Two examples of programs
that are directly fueled by campaign gifts in this
last year are, first, the new UCSF Baker ImmunoX initiative on the Parnassus campus,
led by Max Krummel. The resources that will be made available through the ImmunoX program will drive a revolutionary approach to team science, enabling our clinicians and scientists to analyze the role of the immune system across diseases, from cancer to chronic viral infections to immune-mediated
neurodegeneration and more. The second transformative
gift I would like to highlight is the launch of the new UCSF Dolby Family Center
for Mood Disorders, led by Andrew Krystal. Made possible by a gift from Dagmar Dolby and her son David, this
gift allows our faculty to pursue the ambitious
goals of developing precision medicine treatments
and novel therapeutics for severe mood disorders, such as depression and anxiety. It will also help us create better diagnostic tools to help patients, including those among our
most vulnerable populations, to get the right treatment earlier. As our campaign continues,
I’m excited to share our stories of extraordinary compassion, discovery and education with the world. Let me tell you a little bit about the incoming members
of our UCSF community. This year, we welcomed 906 new learners. 65% are women, and nearly 1/2 were born in California. But in total, 31 countries are represented in our incoming student body. Remarkably, some 27% are first in their generation to attend college, and fully 45% are first
in their generation to attend graduate school. These are statistics that I think we can be rightly proud of. We are fortunate to be able to attract these learners, who are among the best and brightest of their generation. While their journeys to UCSF are varied, they share a desire and dedication to improve the world. Join me now in watching
a video that provides a glimpse into the life
of one of our students. – I grew up in a community of immigrants, refugees and people of color. I didn’t see people from my community becoming professionals
and becoming successful. When you grow up and that’s what you’re surrounded by, it’s hard to imagine that there’s anything better out there. My parents came here with nothing. We lived, eight of us, in a one-bedroom apartment. It was very cozy. My parents both worked multiple jobs to put food on the table
and a roof over our heads. I went to college at UC Berkeley. Even though it was only 10 minutes away, it felt like a different world. When I came back to my
community after college, I noticed that there
were health disparities that disproportionately
affected my hometown. That ended up being a
turning point for me. I decided to pursue
medicine because I realized that communities like
mine were underserved, and that healthcare is
a path towards equity. I chose to go to UCSF because I saw that health equity
and social justice were at the center of their mission. It is so important that
communities like mine have representation in healthcare. To have somebody in the exam room who looks like you, who
speaks the same language, it can really open up doors for folks who have been historically marginalized. I am really grateful to
have gotten the support to get to where I am today. I aspire to spend the rest of my life combating educational
and health disparities. It ensures that communities like mine have representation in healthcare. (audience applauds) This year, we also welcomed
new leaders to UCSF. Michael Reddy, a world-renowned
periodontics specialist, is our new dean of the
School of Dentistry. Brian Newman is our new senior
associate vice chancellor of UCSF Real Estate. He will be an invaluable resource as we re-envisage the
Parnassus Heights campus. I’d also like to introduce two new associate deans in the School of Medicine who highlight the importance of our partnerships and affiliations, a subject I’ll turn to in a minute. Kelley Meade is our new
interim associate dean of Clinical and Academic Affairs at UCSF Benioff Children’s
Hospital Oakland. She will help us develop closer and collaborative relationships on both sides of the Bay. Bruce Ovbiagele, who is the associate dean and chief of staff at
the San Francisco VA. Bruce will continue to ensure
the continued excellence of our affiliation. Welcome to the new leaders. (audience applauds) As San Francisco’s
second largest employer, next to the city and county
of San Francisco itself, UCSF is well served by nearly 20,000 staff who comprise the largest proportion of our campus population. Every year, I have the
pleasure of honoring members of the UCSF
community who have provided exceptional university and public service. We honor the incredible talent, dedication and contributions made by our staff every single day. In addition to these
awards and recognition, we continue to look for
ways to better support our staff by increasing opportunities for their professional development. For instance, this year we kicked off our staff internship
program, which provides practical, hands-on job
experience for staff willing to learn new skills in another UCSF department. Today, we are looking
for additional managers to sign up and help mentor staff interns so that they can grow,
and UCSF can thrive. I also want to acknowledge that this year has been challenging, as the
University of California system continues to negotiate labor contracts for our represented employees. As I’ve emphasized before, we value all of our employees and
respect everyone’s rights to representation and freedom of speech. I thank everyone for maintaining a sense of community and embracing our values during the strikes we have had in the last couple of months. In the month of October,
where we are today, we celebrate Diversity Month. That means we are united as a community by our common set of values and principles to create a culture that welcomes and supports everyone. I encourage all of us
to support one another by living our PRIDE
values: professionalism, respect, integrity, diversity and excellence. We are making progress, steady progress, to advance diversity, equity and inclusion across many fronts. A couple of examples. This year, the percentage of underrepresented
minority medical residents increased from 18 to 29% over the last two years. Our residents represent
a very important pipeline for diversifying our faculty. 40% of the medical school’s class of 2022 self-identified as
underrepresented in medicine, a 21% increase year over year, and the highest percentage
in UCSF history. In other accomplishments, the UCSF Interprofessional Health Post-Baccalaureate Certificate Program was expanded to include
the School of Pharmacy. This development gives prospective underrepresented undergraduate students a stronger academic
foundation to be competitive for applying for pharmacy school. Of the 35 students who
completed the program to date, 83% have been accepted
in a pharmacy school, and 76% into the UCSF Pharmacy School. (audience applauds) Also this year, our UCSF
Latinx Center of Excellence was established with a four-year grant from the U.S. Department of
Health and Human Services, given to School of Medicine faculty member Alicia Fernandez. This center will strengthen
the school’s ongoing efforts to increase diversity, enhance training of Latino physicians and
physician scientists, and heighten awareness of research that can impact the health of now California’s largest ethnic group. (audience applauds) Earlier this month, Renee Navarro, vice chancellor for
Diversity and Outreach, and other campus leaders,
hosted a daylong retreat with representatives from across UCSF. About 150 people at the
retreat generated ideas that will shape our next strategic plan in diversity, equity and inclusion. Despite this progress, we all know we have much more work to do. One area of concern
that surfaced this year in our Gallup Staff Engagement Survey was that black and Hispanic staff members feel less engaged and less
supported in their work than their white and Asian coworkers. I know we are all committed to addressing the issues identified in this survey, not only to improve staff engagement, but to improve equity
and allow UCSF to thrive. Nancy Duranteau and her team in Learning Organization Development are analyzing feedback from the survey, and are holding followup
town halls and focus groups. These forums will inform our action plan to increase staff engagement
and allow everyone to thrive here at UCSF. I invite you to attend a second staff engagement town
hall that will be held in January, where we’ll
have the opportunity to review our action plan
and progress to date. To support our community, we are also creating a built
environment, our facilities where everyone can excel. As you’d undoubtedly
noticed, we are expiring a remarkable period of facilities
growth and improvement. For those of you living and working in and around the Mission Bay and Parnassus Heights campuses, I want to express my deep appreciation for your flexibility and patience (audience laughs) during the ongoing construction. Let me talk just a little bit more about Parnassus Heights,
where we have engaged in an inclusive planning
process that will result in a bold, transformative vision for our historic campus. We will circulate a draft plan for review and feedback this spring,
and we expect to share with you all a roadmap
to sustain our mission of conducting top-tier research, clinical care and education here on the Parnassus Heights campus next year. As for the future of our health system, every day we have the privilege of caring for patients who come to us from all over the Bay Area, California
and, indeed, the world. From primary care to the
most complex conditions, our clinicians and staff
put our patients first at our hospitals and clinics
all around the Bay Area. Much of our growth is in response to unprecedented patient
demand for services provided by our UCSF health system. Every though we opened three new hospitals at Mission Bay just three years ago, our facilities have been operating at near capacity almost every day. To enable us to expand
access to high quality, compassionate care to patients
closer to their homes, we continue to form strategic alliances. Some of the recent partnerships that you may have read about in the last year, including opening the new
Berkeley Outpatient Center, our first jointly operated
and staffed facility with John Muir Health, quite close to the UC Berkeley campus,
expanding our partnership at Washington Township in Fremont and forming a strategic alliance with Marin County General Hospital. Earlier this year, we opened a wonderful new outpatient building on the UCSF Benioff Children’s Hospital campus, and work is ongoing there to complete phase one of that hospital’s
master facility plan. Let me pivot and turn to the second part of my address, our longstanding commitment to the community. Our community service dates back to the founding years in San Francisco, when physicians and trainees rushed to treat victims after
the Great 1906 Earthquake. Over the subsequent
century, we have partnered with our community in many ways. Obviously, time will not allow me today to describe all of these partnerships, but I would like to
highlight just three programs that are making a
difference in our community. Then I will invite two guest speakers to tell us a little about
their work firsthand. This year, the School of Dentistry’s
Community Dental Clinic is celebrating its 25th year of providing free dental services to
San Francisco’s homeless and low-income populations. This student-run operation, with faculty and resident volunteers,
conducts dental screenings with community partners,
including St. Vincent de Paul, Glide and St. Anthony’s. They are expanding their reach this year through services to battered women, refugees and undocumented immigrants. In the past year alone, this clinic has provided more than 1,300 free procedures. A second program that I
would like to highlight is the UCSF Alliance Health Project, a program in our Division of HIV LGBTQ Mental Health Services. This project was started in 1984 during the early years
of the AIDS epidemic. Its early goals were to provide professional mental health services to those with HIV/AIDS and to bring behavioral health
expertise to the challenges of preventing the spread of this disease. Today, the project team
provides a wide range of clinical mental health
and substance abuse services to more than 3,500 people every year. I’m now working with Matt State, our chair of psychiatry,
our elected officials and our donors to see how we can dramatically increase our contribution to the region’s public mental health and substance abuse problems. Lastly, the Center for Science,
Education, and Outreach, led by Don Woodson, in the Office of Diversity and Outreach, is celebrating 20 years of
bringing science to life for the youth in San Francisco’s
Unified School District. This year, the center served more than 3,500 students, 580 families and 30 school counselors. Watch this video that highlights how this program is,
indeed, changing lives. – [Sharon] Nobody in my
neighborhood talks about becoming a surgeon. – [Emmanuel] When I was growing up, I knew I didn’t wanna be a statistic. – [Sharon] Sometimes it’s hard to have a vision for my future. – Every student has some sort of struggle, but all students need is
someone to let them know they could be more than those streets. – [Sharon] I knew it was
time to try something new, something different. – Now I’m in a position to give back and do something meaningful. When I was in seventh grade, my teacher was the first
person to ever tell me I was smart. She made me feel noticed,
and she recommended me to the Early Academic
Outreach Program, or EAOP. – The way I found out about Pitch is through my physics teacher. He thought it was a great way for me to get motivated. – [Emmanuel] Pitch is a
three-week program that helps expose students into the career in the health field that
they’re interested in. The teacher wrote me and email and said, “We have to get Sharon in this program. “She needs to be exposed
to something else.” – It feels nice to know
that Emmanuel has my back. He understands how I feel because we went through a similar situation. I told him how I wanted
to do better in school, and he thought that Pitch program was a great way for me to start. – [Emmanuel] This year, we had 23 students who spent three weeks at UCSF. – [Sharon] We got to meet college students who were currently working on their degree in the medical field. They taught us things
that they were learning in their classes. – They saw themselves as either a doctor, a physical therapist,
a nurse or a surgeon. – Me being involved in the Pitch program has helped me a lot. It was a big transition
for me not having hope to being able to see that I can do bigger things. Being in the Pitch program has helped me gain my confidence. – [Emmanuel] I saw Sharon make friends, participate in ice breakers,
raise her hand in class with her head up high. – [Sharon] If I wanna
learn more things about the medical field, I can
talk to someone about it, and not be shy to ask. – [Emmanuel] Our goal is
to help guide students to be the first in their families to go to and through college. – [Sharon] When I become a
surgeon, I know my family will be speechless. – My hope for UCSF’s Center for Science, Education and Outreach is
that we remain present. Present in providing students the access that they need to be a story like myself, to be a story like Sharon. A story that’s yet to be written so that they themselves
see success in their lives and in their friends’ lives. – One day people will call me Dr. Padilla. (audience applauds) – The star of that video is actually here with us today.
(audience laughs) Could you just stand up and be recognized? (audience applauds and cheers) There is perhaps no stronger way to underscore our
responsibility to address social injustices in our communities than to hear directly from the people who are doing the work. Let me introduce the
first of our two speakers to tell us about her work with children. Dayna Long is the medical director of the Department of Community
Health and Engagement at UCSF Benioff Children’s
Hospital Oakland. She is collaborating with UCSF Benioff Children’s Hospital San Francisco on multidisciplinary clinical programs, trials and partnerships
to address disparities that will help improve
the health of children throughout the Bay Area. Dayna joins us today from Benioff Children’s Hospital Oakland. – Thank you. (audience applauds and cheers) Thank you, Chancellor
Hawgood, and everybody else. As a pediatrician and mom, every time that a young
boy comes to our hospital with a gunshot wound, I think, that could be my son. Every time I see a child that is hungry, homeless or being discriminated against, I think, that could be my child. Childhood matters. Decades of research demonstrate that there are huge disparities
in the health outcomes of children of color,
children who grow up poor, children of immigrant parents, children with disabilities, LGTBQ children and children who suffer
from significant trauma. These disparities are not simply a function of access to healthcare. It is not genes or germs that primarily determine our well-being. The biggest factors are our social and economic circumstances, conditions that have not traditionally been addressed by the healthcare system. At UCSF, we’re challenging
this traditional paradigm and are changing our approach to the practice of medicine. I would like to introduce
you to my patients Mikayla, Joe, Jamal and Miss Cynthia Fowler. (audience applauds and cheers) Eight years ago, Miss Fowler’s oldest son was murdered here in Oakland. Joe and Jamal were toddlers at the time. Their birth mother
struggled with the disease of addiction, delivered them prematurely, and was unable to care for them. In the depths of her grief, and secondary to Mikayla, Miss Fowler opened her
heart to these boys. Joe and Jamal, and Mikayla, certainly suffered from
their own troubles. The family moved a lot. Sometimes they were living
in homeless shelters. All three children have asthma, which is often uncontrolled. Joe developed a serious fungal infection in his lungs. They had made many trips to our hospital, to our emergency
department, and to see me. When we are in clinic together, we listen, we learn, we grow and we heal. We all have a natural stress response that certainly gets us through these challenging times and helps with high-risk situations,
but these young people, they have been in survival mode from the moment they were born, and continue to be every day of their young lives. Joe and Jamal were eventually diagnosed with anxiety, depression and PTSD. Yet in the face of these hardships, and Miss Fowler’s
significant health issues, her love for her children,
her hope for the future and her resourcefulness strengthened the family’s resilience. We now have a framework to address the biologic consequences of what these young people have experienced, and it’s called toxic stress. Toxic stress occurs when a child suffers from strong, frequent and severe adversity, like being sexually assaulted, being separated from a caregiver, witnessing violence or being homeless. Toxic stress results in a range of poor health outcomes, from diabetes to depression. Researchers, including those at UCSF, have found that toxic stress actually gets under a child’s skin, it changes DNA, it changes brain architecture, it weakens the immune system and it impairs hormonal levels. Toxic stress is especially harmful to very young children, since 90% of a child’s brain develops by the time they’re age five. These challenges are examples
of health inequities, the systemic, ingrained and unjust barriers that keep entire segments of
children from being well. It’s imperative to ask, what are we doing to address child health inequities? Our vision is to create a society in which all children and families have the opportunity for health. We’ve established the UCSF
Child Health Equity Institute, embedded in Benioff Children’s
Hospitals in Oakland and San Francisco, and
the School of Medicine. The institute brings together expertise in health equity science,
clinical innovation, community engagement and education. We’re advancing the science by validating the first prospective, preventative pediatric screening tool for
early childhood adversity, identifying biologic markers of stress and developing new mental
health interventions that help build family resilience. We turn evidence into action. We lead clinical innovations by developing technology to screen for basic unmet needs, such as food and housing, and refer families to community-based resources as part of our standard care. We partner with our mayors, state legislators and school districts, as well as the business sector, to improve systemic data sharing and to establish common, measurable goals. We’re informing evidence-based policies that support children and families. We’re building the capacity
for positive change through education and leadership. We train the future generation of the healthcare workforce, from high school students
to postdoc fellows, so that those of us that are actually providing the care understand and mirror the communities that we’re serving. Lastly, we’re becoming trauma transformed. Front-line staff, alongside
senior leadership, are being trained to treat families with empathy and humility. For as an engaged partner, we must be active listeners, not reactionary. We have to be trauma informed, and not trauma producing. Thus shifting the question from what is wrong with our children to what’s happened to our children? What happens to children is our focus. We heal children. Today, we challenge
ourselves to be better. We challenge ourselves to treat every single child as if they are our own. For the best investment that we can actually make to improve society is to invest in Mikayla, Joe and Jamal through research, through
clinical innovation, through advocacy and policy. For healthy children lead
to healthy communities and a healthy world. Thank you. (audience cheers and applauds) – Thank you, Dayna, and thank you to the Fowler family for being present at Benioff Children’s
Hospital Oakland today. We have a lot to be proud of as UCSF forms new partnerships and strengthens long-standing ones. One of UCSF’s oldest
partners, dating back more than a hundred years, is our affiliation with the city and county
Department of Public Health. Joining me here to talk about her efforts to combat the problem of homelessness at Zuckerberg San Francisco General is Margot Kushel, the new director of UCSF’s Center for
Vulnerable Populations. Margot’s research focuses on the causes and consequences of homelessness and housing instability, with a goal of preventing and ending homelessness and its effects on health. Please welcome Margot. (audience applauds) – Thank you, Chancellor Hawgood. When I came to UCSF in
1995, I did not expect to spend my career
focused on homelessness. But as a UCSF medical resident at San Francisco General Hospital in the late 1990s, I
noticed something striking. Nearly 1/2 of the inpatients we cared for were homeless. We would admit them to the hospital, provide the best possible medical care, and then discharge them
back to homelessness. Days later, they would return, even sicker than before. Homelessness has devastating
effects on health, and I knew that we could do better. A wise mentor told me to focus your career on the one thing that upsets you the most, so I focused my career on homelessness. I wanted to understand how
people became homeless, to seek solutions to prevent
and end homelessness. Over the past 20 years,
I’ve had the privilege not only of asking research questions that feel urgent and important, but also translating our
findings into action. I could not have done either of these without partnering closely
with the community. Homelessness is one of the most powerful predictors of health outcomes. Housing improves those outcomes. For people who are homeless,
there is no medicine as powerful as housing. Research our team and
others have conducted over the past 20 years has shown that we can solve homelessness, even for those with the most severe
behavioral conditions. It turns out when you offer people homes with dignity and autonomy,
without preconditions or requirements that they
accept other services, people can be housed successfully. This intervention, called permanent supportive housing, is highly effective. For people experiencing homelessness, their most important priority is finding a safe place to live. I am so proud that it
was here in San Francisco where healthcare providers,
social service providers, housing providers and policymakers worked together to pioneer permanent supportive housing in the late 1990s. This model is now the
standard of care nationwide. With our extraordinarily
high housing costs in San Francisco, we face
unprecedented challenges with homelessness. However, our own work provides us with the roadmap to a solution. I’m inspired by the work of so many of my colleagues. People like Dr. Hemal Kanzaria from Emergency Medicine, and Dr. Jack Chase from Family and Community Medicine, who founded the Emergency Department Social Medicine Consult Service at Zuckerberg San
Francisco General Hospital. This social medicine team brings together a multidisciplinary
team of social workers, care coordination nurses, pharmacists, patient care coordinators,
improvement specialists and others, such as those from the novel EMS 6 group from that fire department, and those from the Department of Public
Health’s Transition Team, to connect patients with
services in the community. Because the team addresses
patients’ true needs, fewer end up hospitalized. Since January 2018, the
Social Medicine Team has served over a thousand patients with complex medical and social needs. During that time, they have prevented more than 230 hospitalizations, decreased hospital lengths of stay and, most importantly,
transformed patients’ lives by helping them exit homelessness. When I do my work, I heed the advice of my brilliant and wonderful colleague Janny Castillo. Janny is a woman with a lived experience of homelessness who leads the Senior Advocates for
Hope and Justice program at St. Mary’s Center in Oakland. Janny and the senior
advocates, most of whom have been homeless,
educate elected officials and others about
homelessness and advocate for effective policies to alleviate poverty. Janny starts every meeting by reminding us to step up and to step back. That is, step up when you
have something to say, but remember to step back to help others find the courage to speak. At UCSF, we all need to encourage one another to step up. In our work, we witness the injustice and suffering in this world. We have the responsibility to speak out about what we see, the ways in which inequities lead to the
degradation of our society, and how poverty, racism and the lack of access to healthcare weaken the body and the spirit. Those of us who are healthcare providers, scientists, students and scholars have a responsibility
to amplify the voices of the community we serve,
to involve ourselves in public discourse and to
seek more just policies. At a time when the principles
of scientific practice and the foundations of
scientific knowledge are under assault, it is
more important than ever that all of us stand
up for the crucial role of science in society. But we also need to step back to allow and encourage others to speak, and we need to listen to
what they are telling us. We must work collaboratively
and learn from those with lived experience, those we work with and those we serve. Humility and acknowledging
others’ expertise does not diminish our
own, but rather increases its depth and breadth. Two decades of research has demonstrated that we actually do know how to solve chronic homelessness. We have a long way to
go, but we must step up to this challenge together. Whether it be seeking
solutions to homelessness or tackling other seemingly
intractable problems, now is the time to take action. (audience applauds) – Thank you, Margot, and thank you both for bringing our connections
to the community alive with your personal and lived experiences. Our connection to the community is, of course, reciprocal. Throughout its history, UCSF has enjoyed tremendous support from the communities in which we are embedded. From our elected officials, our amazing volunteers and supporters, our neighbors and the
public more generally, this ongoing support is
central to our growth and success in the future. In a recent series of
focus groups with members of our adjoining communities, we learned that UCSF is, indeed, a source of pride for our neighbors
because of its excellence in research, education and patient care. But these feelings of pride were dramatically increased
as residents learned about UCSF programs that
benefit the community, like those that you’ve heard about today. As we look to the future, it is clear that UCSF, as one of the Bay
Area’s founding institutions, is positioned well to put our considerable resources, both human and fiscal, to work on making life
better for families, neighbors, patients
and future generations. The long-term vision for UCSF is to continue to evolve as a model multi-site urban health science university that is a trusted anchor institution in our communities. The concept of UCSF as
an anchor institution holds great promise,
and my leadership team and I intend to further pursue the concept and the consequences of
an anchor institution in the coming year. In closing, I want to briefly go back to reflect on the national landscape. Unquestionably, we are living in extraordinarily challenging times. While we as a society
face complex problems at the local, national and global levels, I remain very optimistic
about the contributions that UCSF, we, our community, can make in solving these problems. At UCSF, we have much more in common than what divides us. In the last two years, I’ve been energized by a new wave of activism and advocacy that our UCSF community is demonstrating. Now is not the time to let down our guard. Let us continue to stand up and speak up for our PRIDE values,
as well as unfettered scientific research, healthy equity, and high-quality education
and health for all. Our participation and
engagement as citizens of our local and global community is critical at this time. Indeed, we have a social
and moral responsibility to get involved. I would like to suggest
to you, in closing, that there are two easy ways for us all to make this world a better place, to make your presence, your priorities, your power known. First, volunteer. Share your time and talent with those who need help. Thanks to a new staff-led project proposed by Campus Life Services, we have a program that makes it easier than ever for all of us to volunteer with our coworkers in our community. Called UCSF Volunteers,
this program offers a number of ways to serve the community, and outline how all of
us can work together for a common cause,
strengthening our connections, one to the other, and strengthening UCSF’s mission. Please consider joining
the groups across UCSF that are already volunteering
in our community. Go to the UCSF Volunteers website, sign up and show up. I encourage you all to make a difference. Second, vote. Exercise your constitutional right to make your voice heard on November the 6th. Our democracy depends on an informed and engaged electorate. Many issues are at
stake in these midterms, from protecting healthcare for those with preexisting conditions, to defending transgender identity. The power of our UCSF
community is more than 30,000 strong, and we
can make a difference. Again, I thank Dayna and Margot for their participation in this address. I thank everyone for
attending or watching online. We excel because of
your continued efforts, and I thank you very much. Thank you. (audience applauds)


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