Good morning.

I'd call to order the uh health committee meeting for Monday, November 10th.

Quick word take a roll.

Supervisor Tam.

Present.

Supervisor Miley.

Present.

Any instructions?

For in-person participation.

The meeting site is open to the public.

If you'd like to speak on an item, you can fill out a speaker's card in the front of the room for remote participation.

Use the raise your hand function.

And teleconferencing guidelines are posted at www.acgov.org.

All right.

Thank you.

Okay.

So we have one item this morning's information item, public health commission annual update.

Supervisor Wilde, um commissioners are coming up to the podium.

Just uh some context.

This is our uh regular update that the public health commission provides to the health committee annually, and we also have Director Kimmy Watkins Tart available online if uh you want to elevate your teasing.

Okay, ready?

Good morning, Supervisor Miley and Supervisor Tam.

Thank you for having us here today.

We'll provide an overview of the Public Health Commission, just our annual update about everything that's been going on and just some of our milestones accomplishments and then what's going on with our committee work.

Okay, I'm gonna just skip over this.

Oh, before I forget, let me introduce myself.

So my name is Mitsi de la Penya Medina.

Um I am the chair of the public health commission, and I am from District 5.

And I'm Sally Miss Kelly.

I'm the vice chair of the public health commission.

I'm at large but live in district five.

All righty.

So our mission remains the same.

So our here, our goal is to focus and prevent on health equities, building community um capacities and champions, as well as policy and system changes within the committee, and then as or commission, as well as advocating and for the underserved communities of Alameda County, and as well as accountability for any initiative that is taking place, and then as well develop a vision for the future.

Okay, I don't know if this works.

Okay.

So currently, um, what you have here is our roster.

As you can see, for the most part, we are pretty covered in district four and district two, and at our at large seats.

We do have a few openings for district five as well as the district one and then district three.

With that being said, a lot of our commissioners are um in the newer end, so um, they have either recently joined us this year or the previous year.

Um we still do have a few longtime commissioners, so we still have um Zee, um Commissioner Harper, and then as well as Nestor, Commissioner Castillo.

Um, but I do want to note um Nestor will actually be leaving us this um this year, so he will be stepping down from his seat, making another at-large position open.

All our commissioners come from all different backgrounds with different experiences, um, and everybody has been great at trying to get involved.

I am sure some of these commissioners have reached out to some of you, um to both of you to get um more acquainted, understand what your priorities are as well as how they align to what the department um the department has also prioritized.

Next slide.

So we did recently update our bylaws and um sunseted a couple of our committees, and now we have this structure which includes the health equity and all policy and all policies, nominations, steering, and strategic initiatives.

So the strategic initiatives is a newer committee, and it's more focused on these ad hoc groups that um are temporary groups.

The focus at either an initiative regarding to access to care, housing, mental health, immigration, to name a few, um, and they are led by our commissioners in groups of two or three, where they really then develop a strategic plan on how we want to approach certain initiatives and also then some of them have even reached out to some of the BOS to collaborate more and further these discussions and see what's possible.

This is an effort to really have a cohesive dynamic between the BOS, the department, and then the commission itself.

We want to make sure that there's alignment.

We also want to make sure if there's an initiative already started that we help amplify it versus deterret and also provide feedback, what we see with our community members.

The steering committee is like our leadership committee.

So all the chairs of every one of the subcommittees join together before a week before our meeting, a little bit before, a little bit more than a week before our meeting, and discuss what we want the agenda to look like, as well as bring up any challenges that we are facing within these subcommittees, and then just overall what's going on from our regular meetings, so any follow-up that we need to do.

Then we have our nominations committee, which really tries to focus on having a standardization of our at-large seat interviews, as well as working with the clerk of the board and the department to ensure that we're getting applications and so forth.

They are also now leading the way in not just only recruiting at-large members, but as well as creating a system for our commissioners as they start.

We have noticed that a lot of our commissioners don't have a lot of commission experience or they're new to the system of what it is county bureaucracy.

So our nominations committee tries to focus on developing those tools for them to have a better understanding.

But it's obvious that we're also, you know, it's a volunteer position, so we only have so much time, but there is that gap of a lot of our commissioners don't really know how to work the dynamics of like the county or are knowledgeable on what as a commission we can we can do or amplify.

But the nominations committee has really tried to lead the way on that.

Now for the health equity in all policies, that's a more policy focus, and that really helps focus on the equity of Alameda County residents.

So this group is great about coming together, seeing a gap, and then trying to push a policy forward.

Eventually we want to get to a point that we make these recommendations to you all either during a meeting or during these meetings and so forth.

But we're building up the momentum, but we'll eventually get there.

Next slide.

Okay.

So every year we all get together for a strategic planning retreat where we focus on our past goals for the past year, see if we achieved any anything relating to our last strategic goals that we had developed.

And then as well, this year we had really encouraged all the commissioners to go out and meet with their supervisors or their staffers to get information regarding what those priorities were for the supervisor in order to better have alignment and be more collaborative.

We're trying to make sure that all the commissioners have that open dialogue with supervisors as somebody who was a previous staffer for both Supervisor Canapa and Slocum.

One of the things that we always hide in San Mateo County is the support of me at the time with the committees or the commissions by either going to presentations or having some 101s quarterly with these commissioners, either the chairs or whoever represented the district, in order to make sure that we have alignment in order to either again amplify an initiative or also discuss of some gaps that they saw in the community in order for us to then take charge or focus on a charge.

So again, as the next bullet says, strengthening alignment between public health commission and the department and the board of supervisors is really the goal that we're trying to focus on moving forward, especially for 2026.

And then lastly, identify district-specific countywide priorities to advance health equity and community well-being.

I also am a believer that if you are representing a district, you should also be out there in the community, understanding what the gaps are connecting with community-based organizations and those stakeholders, in order to again bridge that gap between what the community needs are and then what we can do as a commission, or then or let you guys know, so then you guys can follow up as well.

Okay, next slide.

Some of the themes that we develop in the last retreat, and as well as continue to be parts of our discussions are as you see on the slide.

So from the social determinants of health to the health systems and barriers, we really want to ensure that we're pushing for equity and access to all residents of Alameda County, regardless of background.

With everything going on and especially with like the shutdown or the immigration over enforcement, we want to make sure that we are helping amplify any messaging that the department has or the BOS has to community members, but then at the same time offer that dialogue when it comes to interacting with them to then receive that feedback of what the gaps that they are seeing.

And for me personally, I know what I've always gotten is the language barriers.

So all of those things is what encompass our ongoing themes that we have during our meetings and also during our retreat.

Next slide.

So similarly to three D and accountability, and then health equity for immigrants and communities, as I already touched on in the previous slide.

What we need is also just enhance district level data collection and ensure that it guides what we want to do in our priorities for meetings and presentations to then help support any initiative.

And then lastly, immigrant communities, they have been facing many challenges.

Not going to a doctor's because of fear deportation or ICE enforcement.

So also working with the county to understand or the department to understand what is currently being done, and then also then brainstorming if there's any gaps or how we can further strengthen those safety tools that the department can have or the county could have in order to help support their immigrant communities.

Next slide.

Okay, so I'll switch it over to Sally so she can cover our some of our committees.

So our health equity and our policies.

I'm the vice chair for that committee.

And one of the things we are focusing on this year is the social determinants of cancer care.

Cancer being the top all cause mortality for Alameda County.

That is why we wanted to really focus on it and not just look at that as the top cause, but all of the different parts of the social determinants of health that go into equitable cancer care, access to all of the different things that you need to be able to survive cancer, especially in comparison to other counties.

We've done a couple of different things.

One of the nice things we were able to partner with SOCO, which was a presentation, a big conference we had here in Oakland around the trying to remember exactly what it education advocacy, navigation, things like that.

It's the education of cancer care.

That was held here in Oakland in spring.

We were able to partner and do presentations and speak at that as well.

We have also just recently on our next slide here.

It says we have a series of cancer awareness discussion panels.

And on the next slide, we oh this is the leading cause mortality, just showing you what the overall is for Alameda County, the all-cause mortality rate is cancer.

Next slide.

And then really excitingly, we started our first uh presentation event.

This one was cancer care and the social determinants of health, really looking at the despair behind the disparities.

We held that in October for breast cancer awareness month.

This is gonna be a series that we do throughout the year, really diving into the social determinants health, looking at the implications of it, what does that mean for our county and the folks that live in our county?

This was a really nice uh event.

We had folks from all over nationally ranked places as well participating and having conversations about everything from the economy of cancer care and how that is difficult for patients to just the lived experience and really trying to bring in the voice of public, the public that's impacted community members and talking about that as well.

So, not just at an institutional level, but what does that really look like and how is it impacting people on the ground?

So we'll have more of these as we go forward throughout the year, and we're really hoping to be able to go to the different districts, have conversations around some of these things and really understand what it is folks are dealing with and what the community is needing around this, given again that cancer is the top all cause mortality for Alameda County.

Next slide.

Yeah, so from our first S28 SDOH campaign that I just explained, we had the City of Hope Research Institute and the American Cancer Society.

We had a lot of conversation around navigators, which are one of the top, one of the top interventions that really help with social determinants for cancer, public health department staff, and we had a this was our sort of first foray into an event like this.

So we were excited to have 32 different folks there from all different varieties from you know patients and people impacted from cancer to people at an institutional level.

So we're hoping to really continue that and maybe partner in the future on some of these different things so we can dive into what the community is needing.

Great.

So as I mentioned for nominations committee, um, their focus again is to interview applicants uh for the at-large seats.

So we currently have three vacancies, but soon that would be four.

Um they did, or my apologies, there'll be an additional vacancy.

We interview about seven applicants for the three vacancies that we previously had, which now are fulfilled.

So they also are working to incorporate professional training and development into the scope of work, ensuring that they act as a role of mentor to some of the newer commissioners to ensure that they're getting not only introductions but trainings as they further their time with the commission, as well as partner with the Alameda, Alameda County Public Health Department, workforce development and team, development and team, and to extend professional development trainings and learning management systems across members of the departments, council, and commission.

So really focus on ensuring that there's tools for newer members and current members to understand the system a little bit better.

Next slide.

And it is essentially a way to streamline the process when it comes to initiatives that some of the commissioners have.

A lot of the commissioners had really great ideas, but didn't really develop them.

They were just kind of left unsaid or left said and not followed up.

So during this, so we developed the strategic initiatives committee to have that support with their leadership team and they would then meet with the ad hoc members in order to further develop their ideas and guide them on any next steps, depending on the initiative.

It would either be a recommendation to the BOS, to the department, or so forth.

Next slide.

So looking ahead, so as always, what we wanna make sure is that we partner with the BOS.

We want there to be alignment all throughout, and as well, for us to have avenues of discussion when it comes to certain feedback that we might have as the well as develop a standing feedback loops with district staffers.

Additionally, we would love to further explore opportunities for training for commissioners.

As I mentioned, a lot of our commissioners are newer to sit being commissioners, and so a lot of our time currently is taken up by either presentations, providing guidance on what we can do as commissioners, as well as breaking down like what Alameda County currently is, the challenge that it is to navigate Alameda County so that it can better understand that political dynamics.

And we want to get to a stronger point where we can now move forward with recommending initiatives, policies, and so forth.

So am I missing anything else that you want to share?

Yeah, I think I think the other thing is we we have a seat on the measure A committee, and we finally refilled that.

I am on it currently.

There was a kind of a long process to get somebody back into it, and we're now kind of taking a look at that process and the reports and the different things around that.

And one of the things that came up as you know, that committee has now changed it to measure A, um C and W is um, and the bylaws are changing was that sort of um original charter saying uh updates around results-based accountability and and questions around how that is going to be utilized by the board of supervisors with the the different fundings around that and the integration of results-based accountability in that because there is a little bit of a difference now that I'm on it with sort of what the charges and we're being asked, like the results-based accountability stuff is there, but it's not something we actually kind of review.

And so, given that that was part of the original charter, just questions around how that um is gonna be fulfilled or what part the committee is actually going to play in that or not.

That being said, we want to also um say our appreciation to the department, especially Ava, who has helped us when developing these slides, and as well as been the staffer in charge, she plays such a big role for us to make sure everything is streamlined and facilitated, and as well as Kimmy, who's always great about her our court the quarterly reports and providing us just the insights of the department.

So, um, and to you both for having us today um for this meeting and every year.

So we will take any questions at this point.

Okay, thank you for the presentation, Supervisor Jam.

Thank you, Tremiley, and thank you for the presentations and most of all, um, for your service on the commission.

Um, just some background information for me.

So a lot of the commissioners are new.

Do they go through the orientation like the Brown Act process and um, yeah, so for the most part the orientation happens with us that we have recently developed, which is newer to me again, being a staffer in San Mateo San Mateo County, uh the focus was that the uh county Mike Callague would lead um just an orientation for all of the newer commissioners.

So they would go through a training where they would go through Roberts' rules, the Brown Act with County Council, get all that out of the way, and then come back um and then join us as um now with those tool sets.

Okay.

Um do you think the commission in San Mateo County is more active than ours?

Um I would not say that they were more active than ours or even compare because I feel like that's two different dynamics, but I would say from experience with other either commissions or councils um in San Mateo County.

So the office of so OCA, and I'm totally blanking out, but it's my colleagues uh within my colleagues department, what they do is really focus on developing um either binders and tool sets and and then as well as providing like an educational uh training with county council um to better streamline as commissioners join these committees or commissions.

I think that's important because then that takes um away from us having to focus on training commissioners about what it is to be a commissioner, and it also gives them a list of contacts of where they can ask for more information and you know if they have any doubts.

I mean, as something as simple moving forward a motion, um it's something new to the commissioners, which I mean it's fair.

When I was, you know, when I was back then a staffer, that was also my thought process.

Like, oh, I didn't know that there was a formal process to do stuff.

So if we can get those um out of the way, like the the trainings and the experience that would really help support moving forward on these commissioners' focus on gaps, initiatives and ideas.

Okay.

And just just to add to that, it it is a it is a gap in where Mitzi and I are trying to fill that and really help, you know, nurture them around those types of things and learn about the Brown Act and learn about how do we sort of move these things along, but it does delay things, right?

If we're if they start and it's probably three months in, that they're really understanding the Brown Act and understanding how to make a motion and that you know how to even um how many times they have to be present and meet quorum and you know how many times can they call in virtually?

It's a steep learning curve, and I think that does delay some of the types of things we can do because it's internal um commission support that they're getting versus you know, at a at the higher level with the county.

And and then lastly, I would like to add because it was under um the Office of Community Affairs, um, or it is currently in San Mateo County with Mike Calaghi.

It's a neutral party, it's the county executive's office, not the BOS, not uh the commission staff.

So it also provides an avenue for them to um not feel like um how do I say there's like a conflict of interests if they're asking for help or how we're teaching them, they might feel a certain way if they maybe they found out there's a different avenue to go about things, which is totally valid.

It takes away um that responsibility from the commission and more to a neutral party that helps educate them and becomes the avenue for questions um later on.

Okay, um, that's something we should probably think about.

I know um the county council's office is short staff.

I think Vicky in the past has done a lot of the the training, but maybe we can um do something similar to like AB 1234 and have it done online so people you ones can take um that um course.

Absolutely.

Uh that's a good suggestion.

Um the issues that you raised on identifying some of the county themes and priorities.

I appreciate your helping us get the pulse of the community on this.

And my office has been working on uh bringing to the full board a language access policy, and that's something we would like to uh partner with the public health commission because that is something you identified specifically as a need and a fear, particularly in the immigrant community, and so um our office will be contacting you to find a way to get that before your commission as well.

Um the one thing I wanted to check in with you on is I've had um a number of meetings lately with the city of Oakland, and it has to do with the the measure C funding and maybe some of the measure W funding, and the you you mentioned how it's a look back when we do measure C, measure W, and measure A.

But I think the commission obviously you talked about an opportunity to be proactive and to help shape some of those discussions.

The one area that I've been focusing on, it was with the Department of Violence Prevention and using some of the measures C funding to address some of the trauma that um human trafficked women in particular are going through.

Um, do you are you sensing that's an issue that uh the commission should weigh in on?

I definitely think that that is an issue, and and certainly for Oakland has been a kind of a long-standing issue.

I think that it would be great for us to be able to weigh in on some of that.

It it I think it's a really strategic use of that funding.

And Supervisor Tam, I just wanted to add to your language access.

So that actually came up from Supervisor Slocum's office, and I helped develop that as well with Mike Allight in the OCA office.

So I'm more than happy to help you in any way when it comes to best practices, and then as well as some of the challenges that we face, but then overall how we were able to make it successful.

That's that'd be great.

Thank you.

Um the last question I had pertains to um some of the work that um uh we're going through with the air board.

So you identified cancer as one of the major areas where the social determinants of health are are you looking at like geographically where that's focused on uh and and some of them um environmental factors that are affecting because one of the issues that came up recently on the airboard is a study that CalTrans is undertaking between the 880 corridor and the the 580 corridor and how trucks were banned at one time and the 580 corridor and um where is is the issue around um cancer prevalence more focused on those corridors or are they more around the areas with like um you know the the water situation that yeah water quality issues you have in Pleasanton?

It's it's different depending on the type of cancer.

So there's a really great tool from UCSF that you can even break it down by zip code and really look at the what's going on in each geographic area that that we can use and definitely can send out that gives you they they spent many years, I think, developing this, and it's it's nationally, but you can look at it locally obviously as well as as by the regions.

Uh it really is different depending on the cancer type, and there's a variety and when you look, you pull the data and you look at for the county.

There's um there's a variety of different different cancers going on, and the prevalence of the types of cancer are different by uh geographic region as well.

And then, of course, comparing it to um all the Bay Area counties, you start to see some real differences as well.

But you're saying that that's uh a significant issue in Alameda County yes in particular, but not necessarily um during certain areas within the county or there definitely are different areas where there are higher cancer prevalence for sure.

And Supervisor Tim what we can do is set up a meeting and then have um our um health in all policies chair and as well as uh commissioner uh miscelly join you and have a further like dialogue about other opportunities where we think we can maximize our efforts if we both collaborate uh with your office um and the department to better serve alamedo county residents and just for example like there are really high rates of prostate and lung cancer in Alameda County and the mortality from that is extremely high um as compared to other areas that may even have high rates of it but the mortality is not as high so there's both um higher rates and higher mortality from it okay I appreciate that uh clarification um that's all I had thank you for your hard work all right so supervisor Tam asked a lot of questions some of which I want to also weigh in on so if we could uh put put this slide back up but before while that's coming up so yeah I know I haven't met with the Health Commission Public Health Commission in a while um Aaron Armstrong should be my liaison to the commission as is my office met with the commission.

Um you know I would have to assist the district I believe they have an if they not I will make sure that they reached out but they're pretty great about uh reaching out to your guys' office I believe Gary um Howard reached out so potentially him yeah yeah because um I know I personally haven't been to a commission meeting in quite a while uh but I have staff that staff all the different board yeah committees and since this falls under health this would be that would be amazing I mean I used to do um present quarterly uh presentations to these commissions about what the supervisor was doing so if maybe we can implement that quarterly that would be amazing just to again to highlight alignment and sure that we are also collaborating um and amplifying what you guys are doing from our end to community yeah so she's the person and she just started this year you are new yeah so in the past it could have been another staff person.

It might have been then yeah okay uh great um and then yeah I appreciate uh the focus because looking at this clearly cancer is really um significant um and to be focused on that is uh very uh important I was kind of surprised you know we spent a lot of time on violence prevention but homicides wasn't really um you know up there uh heart disease stroke I mean Alzheimer's disease um unintentional overdoses those are the top five right yeah homicides you know uh I see on uh less than 11 then uh 67 then we've got 29 and that I don't even see homicides anywhere else on the um age breakout yeah because I would suspect to them this is a question I've asked before and I don't know if you can answer it I suspect that these homicides are pretty much if not 100% 90% Oakland.

Or do you know?

Well I'm not gonna say for certain so have I follow back up with the actual data I think that would be uh a better way so then we can also have that dialogue on ways of addressing the situation or help support you guys in any thoughts and initiatives you guys already have in mind, and as well, you know, being collaborative with the city of Oakland, if that were be to be the case, um, to do that.

Because I know Supervisor Dam and I really pushed the agency in the department, um, and also uh the office the office of the Center for Healthy Schools in neighborhoods on measure C money and allocating additional monies for violence prevention.

We really pushed hard on that, and I think that was the right thing to do, but in terms of the overall picture, homicides is really insignificant.

Right.

And I honestly it's a team effort, right?

So the department has always been really great to provide this information and highlight um what the impacts that we are seeing with our residents are.

So um, you know, putting like the group together and really focusing on developing something, seeing where there's gaps, and then seeing what we can help amplify or start an initiative, that would be um I think a great start in order to support residents of Alameda County.

And just to point out with this with this information, you have cancer there, and it's not broken out um into which types of cancer, but you know, lung cancer is one of the ones that's really prevalent in Alameda County.

There's also chronic lower respiratory disease, which is also fed in by pollution and things like that, which is on here for the top three age groups is one of the top five.

So there's other impacts as you were talking about with pollution and things that aren't always just cancer, but are other types of mortality and morbidity and things, so there's impacts in a lot of different ways.

Yeah, so uh yeah, because Supervisor Tam, you know, she's on the Air B area quality management district.

I served on it for 24 years, and Aaron does track all that for me.

Uh the 580 study with the drug band and you know uh the work that we're doing with um uh the uh East Oakland um community around air quality.

So yeah, uh we're definitely you know interested in in all of that.

But yeah, this is a fascinating chart here, yeah.

Yeah, and um, I will say we proactively reached out to CalCrance uh regarding um that the I-580 study that they're doing.

Um so just making sure again accountability is important.

So one of our biggest asks was to ensure that they're working with the supervisors, working with the department, so we can have input all throughout, and as well as I know some of the feedback was the meetings, the time, and the language barriers.

Um really important aspects of ensuring that we get the information from the public is ensuring that they have access to the information and have access to providing input.

Um, in order for us to better move forward from this, that's gonna be crucial.

Did you want to say something?

Yeah, I just wanted to note on the data supervisors.

So um, you know, and I'm sure the commissioners might know this is that at our next joint health and public protection committee, we'll be doing a deeper dive into the homicide data, and and so there'll that'll be there.

But the and another thing that we do on an annual basis is uh mortality and morbidity report for Alameda County, which digs deeper into this overview chart that you see here.

Um, you know, and in terms of priorities, the a lot of the chronic disease stuff and cancer, you know, it it's a cumulative impact that's gonna add up as you get older.

Um, and when we think about investments and you know years of life lost, uh, if you're seeing a huge increase in that zero to eighteen, um that means that we're really, you know, with homicide with younger people, we're um it's a big opportunity loss, right?

For in terms of lives that could be lived to uh to do additional work later, but just to on the data, there will be more um more details coming forward.

Okay, and also um I'd be interested in in having some more information around the suicides, too.

But once again, it doesn't, you know, it's not significant, but uh that'll be a part of the violence permission.

We see 39, and then we see 29, and then I don't think we see any other suicides anywhere else.

Okay, um let me uh move on to something else.

The um, when does the uh public health commission meet?

We're meeting in this Thursday, so if you guys want to attend or send a staffer, please do.

You meet out in Barcadero.

Where do you meet?

Um yes, I believe is it in Barcadero?

No, where do you meet?

It's it's in San Leandro.

Oh, yeah.

At the public health uh there.

Okay.

And we we meet the second uh Thursday of every month.

Oh, you're meetings virtual?

They are they do, we have a virtual option.

People can come in person or they can participate virtually.

Okay, now commissioners they have to be in an attendance to participate.

They have to follow, you know, with the Brown Act.

So if they were not going to be in person, they would need to give an address in advance so that it can be published.

Um, and then there's like a limit to how many times they could do that.

So most of us are in person, and then as needed, a few folks, and then of course they have to be in the in the county.

They can't be like in another state attending virtually, or they would just be public.

Yeah, because I keep telling the agency director and Kimmy, I've got to get out to the um office.

Because you know, public health used to be located down here, and when they moved, I still haven't gotten out to, you know, where all the action is.

At some point I'm gonna get out there.

Yeah, Erin and I, we're gonna take a little tour and get out there.

Uh, my schedule's just been really, really busy.

No, we totally understand, but I will say the department has been amazing.

So the work that they're doing is incredible.

Um, and I forgot to mention also, you bet she's been great as well, wonderful, all of them.

So definitely you should take the time to go out there and just check it out and see all the amazing work that they're doing.

Just between you and them, you know.

Great.

Now, something Supervisor Tam mentioned, and I'm glad you brought it up, the vacancies and the training and stuff.

The oblig you should not have the obligation to have to train people.

That should not be your function and your role.

I I was quite surprised to hear that.

But like Supervisor Tam said, County Council is very short.

I mean, and obviously, you know we had the pandemic, then after pandemic, we had the post-pandemic, the recovery, then we got all sorts of mess going on with this administration and homelessness.

And I mean, it's like it it just hasn't let up in county and then staff, the staffing challenges have been very um, I don't want to say overwhelming, but they've been very difficult.

So I think because yeah, that shouldn't be your obligation.

Um, and hopefully, you know, when I was president of the board uh about two years ago, I tried to push that agenda because you know we have about a hundred boards and commissions, and some of the and we've done a study, and some commissions we need to quite frankly uh eliminate, others we need to uh consolidate, others we need to you know um move forward on, and then there's new ones that we're looking at uh creating, and we need to really look at how we manage all of the commissions.

The way we go about it now, I think needs to be you know tweaked and fine-tuned.

I think you've mentioned some of that.

Um, and maybe when Supervisor Tam is the president of the board, I think you'll probably be president next year.

She because David's time, time's almost up.

I mean, it's October.

That's actually it's November.

I mean, the boards and commissions, we've had this study for at least four years or more, and trying to get some movement on how we're gonna address the all the boards and commissions that we have uh has been, I think, daunting.

But I do think the training should be centralized, it shouldn't be coming from the you know, the commission chair and vice chair, it should be centralized.

There should be some basic orientation that's taking place.

Like Supervisor Tam said, maybe it could be online, whatever.

But the point is that shouldn't be your role and function.

Yeah, and I would like to clarify.

I know the department also then helps bring in somebody from county council to ensure that there's alignment, but um, what I was more referencing to is that again, and and I hate to compare to San Mateo County, that's just where I was a staffer, so that's where my experience was.

Um in San Mateo County, count county council has uh a lawyer who is focused on just boards and commissions and the Brown Act and uh Roberts rules.

So their sole focus is to make sure that there's alignment with in each and every one of these commissions, and nobody is just, you know, meeting trust to meet.

Um, they also then make um recommendations to right now.

I believe John Nibblin' to make sure that um he then tells Mike Calaghi, hey, these are the commissions that are working within their parameters, these are the ones that might be then you know tied by the board.

So um, and they all stem from again the county executive's office purposely.

So then the department doesn't feel like you know they're um influencing the commissioner, and then as well, county staff doesn't also, or sorry, um your guys' staff doesn't also feel like they are tied to um all interest and alignment, it becomes more of a way to create dialogue and open honesty, and then having a network to then tap into in case they have questions of how to move forward.

Yeah.

Well, I really really hope.

I mean, it's something I've tried to get us to get resolved, the whole board and commission situation, as president, and you know, we started working on it before as president.

I really hope we can get this, you know.

I mean, obviously, it has I'm not I'm not blaming anyone because obviously we had the pandemic and that really threw things off.

Then we've kind of had the post-pandemic and everything else that's been occurring, but obviously the boards and commissions is you know something that's been relegated to a non-priority that we've got to the county administrator's got a lot coming at her, yeah.

So I'm not trying to you know um criticize her either, but I just hope we can get something done off our plate and then you know put a better system in place.

Because I really hate for David Canaba supervisor over there to be able to brag about something that they're doing that we aren't doing as well, and I don't supervisor Dan knows David, because he's on oh no, he's not on the air on the airboard anymore, but you know David through other ways, right?

No, the supervisors from uh San Mateo County are different now.

Yeah, yeah, no.

I mean, again, as supervisor um again, uh he you probably laugh at this, but he did you know empower me to always tell me, hey, where are there gaps?

We're gonna go and bother my callighy.

Bless Mike Calaghi.

He till this day, he's such a great person that I know I can reach out to, and he always tells me, hey, there's always a job out there in the county if you need one.

So I always appreciate him.

But there was that dialogue constantly, right?

Of hey, there's these gaps, let's address them, let's figure out how we're gonna navigate it.

So what I can say is I'm more than happy to offer my support and as well as uh the vice chair to um help share best practices and then um highlight some of like the um impact that really made a difference post um having that structure in place.

Okay, just just to say as well, I think you'll find some you'll get some time back from staffers and folks that are doing this now.

So, like in our case, we're getting a lot of assistance from the public health department staff that are assigned to us.

I would imagine with all the other boards and commissions, somebody else is filling this gap as well, right?

And so if you do centralize it or you do figure out the process for it, you're gonna get some time back from all of these folks as well in the end.

Yeah.

And then you asked the question of um uh measure W, measure A, measure C, and the fact that we've combined um the oversight body or oversight functions uh for measure C, A, and W, uh and results-based accountability, I believe you're asking some.

And I don't know if I quite caught it, but I wanted to see if the um agency director uh could respond to that.

Yeah, that'd be great.

Yeah, so did you want me to rephrase it or I think what I heard was that um you were wondering how the results-based accountability uh component will be carried through in the new iteration?

Yeah, yeah, because um what I have learned, and I've only been to two meetings, so I'll give that caveat.

Um, as we're going through the reports, there's a section on there for results-based accountability, but it's in we've been in structure that's not actually what we're analyzing.

We're analyzing the financials of it.

And so I'm wondering where the results-based accountability comes into play and like how that is analyzed as these you know, millions and millions of dollars are being spent.

Are we just collecting the data or is there an analyzation process around what's effective?

So, um, thanks for that question, and it's a a good clarification point.

The uh results-based accountability, as you know, is an overall countywide framework that we apply to all of our contracts.

So in the contract monitoring process and in the contract development process, each contract is required to say, you know, how much, what, and who's better off.

Um, and so that's measured as a part of uh at the contract and program level and at the department level.

Um, and during our um budget development process, you know, we help the uh with the development of the budget narrative that goes into the budget book.

Um so that comes, we rely on that results-based accountability framework to be able to talk um to share highlights of what's working well in the budget book.

Um, programs also use that information to do their ongoing evaluations and in any like future contract developments to see like, hey, this thing that we tried wasn't working well, and and now let's try that again.

Um all of those functions are separate from the measure ACW look back function, uh, which is intended to be a way for um county residents to be able to say that the money was spent in accordance with any uh ordinances or the measure itself or board guidance in the case of measure W.

So that function really is a finance function where you're looking back to say that you know, oh, measure A, for example, is for healthcare.

Um, and what you're looking for is that you don't see something coming along there where it's like, oh, this money went to buy shoes for something that was not healthcare related, right?

So it's it's kind of intended to be at that point.

Um, the way the committee works is that you'll have presentations from different organizations that receive funding.

Um and there is an opportunity for the committee to ask questions related to how things are going, or you know, what recommendations might be there.

Um but this is sort of an ongoing, you know, uh thing that we work through with that committee is that the function itself is a look back and not necessarily an advisory one, right?

So um, but that said, uh, because we have staff that are helping to support um the look back functions who are also involved in other functions, any feedback and things that they hear, they do incorporate into their work elsewhere.

It just doesn't happen as a formal function of that committee.

And and just to be clear, because the that piece of it I I understand.

I think there is confusion among the group um around that piece of it and and how the results-based accountability actually factor into it.

So it sounds like you're looking at it at a county level and it impacts the next year's contract and what you might change around it, but there's never a point where it's like they've consistently you know not met this goal or they have not done that that it would be evaluated whether you should that's swap.

That's at the program level, right?

So the each program as they're looking at it, um, as they're doing the contract monitoring, they should be looking at like, oh, this is you're not meeting your metrics, you're not, you know, and then it gets evaluated in a different way.

Okay.

That's helpful.

So I have a two other questions or comments to follow up on.

Now let's go back to the the um the commission.

Uh the public health, in fact, is like I said, the board, we have about over 100 commission boards and commissions, some of them are mandated, so we have to have those commissions.

Um, I don't believe the public health commission is mandated, but I do think it's an important commission.

Now uh with the look back commission for measure W, Measure C, and measure A.

We've also asked the staff, and they're bringing that report to the board uh very soon.

I think it's next week, possibly, because we wanted to make sure you know the two of us that uh that combined look back commission, uh, you get a stipend.

Uh, uh because on the public health commission, you don't get a stipend, do you know?

No.

Yeah.

Do they even give you food?

They do on Thursday.

Yeah.

All right, that's good.

That's good.

Okay.

Because I'm not saying, because that's the other thing that we need to figure out.

We can't afford to have a stipend for all commissions, but I do think certain boards and commissions should get a stipend, like our planning commission, that's mandated they get a stipend.

So the board just needs to have something that determines what commissions get stipends and what don't, and what's the criteria?

Uh so that's something I just wanted to put out there.

And I would like to add to that, so um, that would definitely help, especially then have a presentation, right, on our um or any board and commission.

When sometimes because it is volunteer work, right?

Some people just don't have the capacity to do um to join these type of commissions because they need to go get another job, or they need to, or they're they can't take off that time from work in order to be present.

So even looking at as more of a health equity lens as well, um, that's a great like starting jumping off point, um, is helping support either in transportation, um, or um just an access to even taking part as a volunteer in the um in the commissions would be beneficial.

Again, um, you know, not one size fits all, but I'm happy to also then share any best practices I I learned prior.

Did the commissioners get a stipend in San Mateo?

Yeah, all of them.

So not all of them, but um, for example, then North Barrows Community Council, which is um an unincorporated part of San Mateo County, it's in Redwood City, they wouldn't get a commission, but they would um get uh food as well as other um like supporting things like um what is it like transportation um like tickets or some or whatever that be also it was located central so to ensure that everybody had access there, but um what the commission or the committee did push for or the council pushed for is having uh language access there every meeting.

So uh we had um an interpreter at every single meeting join um joined to provide that and after that we saw a large turnout rate um with community members who didn't speak the language, didn't speak English, now we're able to communicate in Spanish since it's highly uh populated with Spanish speakers there.

And Slocum, Supervisor Slocum at the time, he saw um all the great feedback that we were receiving because of that.

So there's not necessarily um just about stipends but also seeing what if there's any funds we can allocate to help support dialogue from community members is also another avenue that can help.

I would also say not having transportation or stipend, it kind of ensures that we're overrepresented with uh health professionals, which is great, and I'm a health professional, and we we all have a purpose.

But one of the things we've really wanted to do is make sure we have space and for folks with lived experience and in the community to be able to be a part of these types of commissions.

We have many seats, and um to really have like robust diversity and inclusion in that and and differing opinions being brought to the table because it's very different if you have a room full of health professionals versus community uh actively being able to come and participate.

We certainly try to solicit from the community, but it's different if they can have a seat at the table.

Yeah, and then you know, just from my perspective, so to speak, from my own perspective, clearly we want to encourage participation, we want to um provide incentives for participating, and in some cases, just getting on the commission, a commission is significant enough of an incentive, but I do know, um, you know, food or language, um, and you know, there should be some basics for all of our commissions that are just fundamental now, in terms of whether or not a a commission uh is allocated a stipend, you know.

You know, I think we need to establish criteria because we just don't want to go down um a slippery slope, because if every commissioner on every board and commission needs to get a stipend, um that's a budgetary issues that the county would have to uh look at.

Um, so I I just think it's something we need to continue to grapple with and um and kind of figure out how we want to approach that, which commissions, and then if we determine a commission is going to get a stipend.

I think the stipend needs to be provided to all commissioners, because once again, it's not a job.

It's not a job, it's just to provide an incentive to participate uh and to ensure participation.

I know it'll be easier to I think under the new law that becomes in effect next year where commissioners can participate virtually.

I believe so.

Yeah, I think that new law kicks in that might help some commissioners who you know have a challenge getting somewhere because of travel or whatever that they could uh fully participate virtually.

Absolutely.

Another just thing to add, um, I will say that what also would be helpful in um just kind of as a standard.

One of the things um I took again, sorry for mentioning San Mateo County, like for the millionth time, but um in San Mateo County, what we did have all the boards and commission had like a table runner, had um, you felt like you were part of a commission, um, and already there's a sense of pride, right?

If we have um what do I say, like not just like the logo, but like uh business cards and so forth, to it's like a package that comes all together that usually is brought by whoever's staffing it who sets it up, and um again, it goes back to just like the aesthetic of things.

A lot of people then sense a lot more pride when they see the professionalism of it.

Now, I'm not saying that that doesn't happen with a department.

Um I just think it it was like a process of a like, oh, like let's discuss about ideas, and we eventually got there and with support.

But what I'm what I'm trying to get at is as you guys think about moving forward, having just like a standardized, um, just like what is it, um, not bucket, but like box of like this is the runner, this is like um the standard of like name cards, this is a standard of like communications and stuff, all um, so that all the commissioners are aware, definitely um kind of ties everything nicely together.

And I do like the idea of having one county council assigned to you know do everything associated with the commissions.

I mean, that's not the case presently, but I wouldn't have us do that just yet until we've kind of really figured out how we're gonna move forward with absolutely managing our commissioners.

And you know, I'm just on this on this rant because you kind of brought it up from the public health commission perspective, and it's something that's bugged me for you know, at least six, seven, eight years.

So maybe supervising.

Keep in mind we had the pandemic, so we gotta, you know, everything was thrown off of course with the pandemic, but I got a lot of confidence in her and her office, uh, I'll back them up.

But um, let's see here.

The other thing is uh under your strategic initiatives, housing, uh, that's a work group.

Um, mental health, uh, and public safety, that's one of the under strategic initiatives, that's one of the ad hoc work groups, right?

Correct.

And I will say so the ad hoc groups are not like a stand a standing committee, right?

So the title itself is because we don't actually have on me right now um the name of whatever initiative that they're focusing on.

So because it is an ad hoc, um, they're supposed to develop the action item and then after doing the research with community with the board of supervisors in the department, um, find a solution if there's one.

Um, and then put it uh presented at either strategic initiatives committee or uh during a regular one of our regular commission meetings, so then we would put it up to a vote and then send it to you guys or the department or whatever avenue it is.

Um this is to be more proactive.

If we see something, also um do the work, the baseline work in order for uh let's say, your guys' office to like then put your backing behind it, and then it becomes a joint effort.

So these ad hocs are just the title is an overview of what the focus is or the subject is on.

And then they're still developing these initiatives.

So next year we will have a lot of these ad hoc groups come to us for presentations, and then we will make sure to send the recommendations to you guys.

Yeah, and just to say the ad hoc groups are more tactical.

Like there's the strategic initiatives, and then the ad hocs are meant to be more tactical, a little bit more agile because they're not subject to the different same regulations as a standing committee, so people can meet more easily, more frequently, work through some of these things and present something.

There's some ad hoc groups that have already met this year, and they were like, actually, there's not much for us to be done on this piece of it.

And so they've sunset it already.

And the expectation is by the time we get net to our next strategic retreat, they're gonna have measurable things that they've worked on and have, you know, the the charge that they had, which was to figure out what they want to do, what we want to do as a public health commission on this.

So we're expecting in the new year for them to start presenting what it is they want to do, or again, if they if they don't have an action item, they'll they'll be censored.

And I think I'm not suggesting you don't do this, but I would just um caution you because we have commissions, mental health commission, we have a homeless commission, housing and homeless commission, I believe.

We've that if you're going down those those avenues to, you know, to kind of make try to see what they're what they're doing, so either you don't duplicate it or you don't run contrary.

And that's a great point, Supervisor.

And a lot of our commissioners are actually doing that.

So it's also this is also helping them understand the dynamics politically in Alameda County.

So all of us have really great ideas and have a hundred and one million ways to find um solutions when it comes to these issues.

Sometimes it takes you know the research and the understanding or the connecting with other groups to then really realize oh, wait, something's already doing uh something, or how can we help amplify and collaborate with one another?

Um, so we have had um again the purpose of these ad hoc groups is to do that, to start with the research, um, especially a lot of these commissioners are passionate about whatever subject that they're focused on are.

So it provides that avenue to do research to understand dynamics, and then it's bundled through our strategic initiatives uh leadership team who then says, Oh, okay, these are all the pieces you got.

Let me put the puzzle together so we can form a recommendation, or is it better just to let it be for now and let's revisit it later?

So, for example, that happened with the one that is sunsetted, they found out that actually what they're working on were working on or wanting to is was duplicative.

So we didn't need to continue with that.

They did their research, they reached out to other boards and commissions, and we're like, okay, well, there's nothing we really need to do on this, we're not gonna duplicate what they're already doing.

So that was that, and we sunset it, but we did our um sort of due diligence on it to make sure there is something happening on it, and uh now we can move on to other things.

Okay, all right.

Well, I've asked a lot of questions and you've given me a lot of responses with supervisor 10 again.

Yeah, I just um wanted to follow up on something real quickly and um thank Supervisor Corzo and Moeller from your county for representing on the airport.

Um, do you think 25 people is a lot for a commission?

Yeah, four from each supervisor and then five at large.

Well, I will say this.

The commission is working right now, which is great, but this is the first time I've had uh been part of a commission where there's so many people representing each district.

Usually it is one or two, with one or two at large.

That's not to say um, let's go cut everything down.

I do think it's worth um having dialogue and discussion with um all the commission, all the commissions and seeing what is working, what is not.

But I will say from experience, and this is all throughout the nation and commissions I've been on, or either just, you know, participated in this is the first time I've had so many in just one place.

Yeah, it is quite a it is quite a bit, which there are pros and cons to it, right?

Like it is hard to keep them all filled, um, and it's hard to come to agreement when you have so many folks.

Uh, but it also does with the turnover and different things like that.

We pretty much always have representation for every district, and so that part has been really nice.

There's never been a time where there was zero vacancy for for a district, so there are some benefits, and there are some challenges with it as well.

All right, do we have any public speakers on this item?

Did you want to have something?

I just wanted to note a couple of things.

Um, in terms of the the commit the boards and commissions work, you know, historically uh it's been up to the departments to support our commissions and and boards, and we do that in a variety of different ways, but I'm also hearing an opportunity for us to sort of look across our agency to see um how we're doing that.

Um, so for example, some of the things that uh, you know, you had brought up about food and transportation supports, etc.

Um, our HIV prevention council or HIV council, for example, uh our federal grants require us to do some of that work, right?

So we're happy to help uh take a look at how things are functioning across our agency in support of the the work at the county administrator's office.

Um I also wanted to note just the um it it also sounds like there's a lot of uh opportunity in connection with the community health improvement plan that the public health department leads, and so in terms of any coordination that we're doing with board offices and with the commission, I sort of want to make sure that our public health department has a chance to be engaged there as well because um the those key priorities in the ad hoc areas are things that are uh a part of our identified community health improvement plan and are also things that as you noted Supervisor Miley, the county and other departments within our agency are doing, and so to the extent that we can help support education for the public health commission, we're happy to do that.

Um, and lastly, I just wanted to know.

I know uh Director Watkins Tart has been having some challenges logging on, and so Tisa, I'm wondering if we can find her.

If so, I'd love to, in case there's anything she'd want to add.

Kimmy, you want to try raising your hand again?

The Zooms were not in her favor today, so.

Well, I do appreciate your um your thoughtfulness around this, uh, because the the um Alameda County Health and the Social Services Agency, uh, those two agencies probably have you know a healthy amount of boards and commissions that are within your different uh departments and those agencies.

So if if uh there's a you know the recommendations uh from the two agencies, how better to work with the boards and commissions that are within your agencies and your separate departments, I think that'd be helpful as well.

Yeah, and since you know Supervisor Dam is on both committees, I'm gonna throw this out again, she's on both committees.

Social services, Chair said she's on health, and she's gonna be the board president next year, you know.

He's manifesting this for you.

Actually, uh Supervisor However is still board president.

President now, but his term's almost over.

Yeah, I'm already into 2026.

Okay, right.

Is Kimmy on?

Okay, all right.

Do we have any public comment on this item?

No, we have no comment on this item.

All right, all right.

Okay.

Well, thanks for this um presentation, it's been very informative.

You've given us a lot of food for thought.

Uh, we definitely appreciate all the work of the Public Health commission and all of our commissions, and so we're gonna continue to see how we can be um uh you know supportive because the commissions do add value to the county.

You know, we've got commissions, we've got community-based organizations, you know, we've got you know an active, you know, constituency.

I mean, it's just so much going on.

So we appreciate the help that you provide us.

Thank you to both of you guys.

And again, uh, we will make sure to contact her as his health staffer, and so uh moving forward we can continue with this amazing dialogue.

And um, if we can be of any assistance, please do not hesitate to let us know.

Thank you.

Do we have any speakers on non-agendized items today?

No, we have no speakers for public comment.

Okay, so our next meeting, let's see.

Are we meeting again before the end of the month?

Okay, is it is it uh the Tuesday, Monday after Thanksgiving?

No, the Monday before Thanksgiving, the twenty fourth.

Okay.

All right, so we're adjourned and we'll see everybody at our next meeting.

Thank you