San Francisco Burden of Disease & Injury Study:
Determinants of Health
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Poor Diet: What Can Be Done?

Below are some examples of how the "spectrum of prevention" approach might be applied to improving nutrition in San Francisco.

Level of Spectrum


Influencing Policy and Legislation

Various neighborhood groups are working on establishing new farmers' markets in San Francisco (Panhandle of GG Park, the Fillmore). There are already three large farmers' markets (Saturdays at Ferry Plaza, Sundays & Wednesdays at UN Plaza, and Saturdays at Alemany Boulevard). They increase access to fresh fruits and vegetables.

Mobilizing Neighborhoods and Communities

DPH Nutritional Services is working in the Mission (Mission Latino Partnership) to promote increased fruit and vegetable intake.

San Francisco Food Systems is engaged in a number of activities that bridge people to healthy, nutritious, affordable, locally and regionally grown food. Their actions represent a broad and diverse approach that includes community research and organizing, capacity building, promotion of collaborations and partnerships, policy activities, and advocacy.

Fostering Coalitions and Networks

Physical Activity & Nutrition: The Department of Children, Youth, and Families works with the SF Unified School District and various City Departments (including Public Health) to increase physical activity & improve nutrition among SF youth.

Physical Activity & Nutrition: The SF Community Clinic Consortium, Kaiser Permanente, and the SF Department of Public Health are establishing a collaboration that will prevent diabetes and improve its treatment in the Inner Mission.

Changing Organizational Practices

Physical Activity & Nutrition: The inclusion of Body Mass Index (BMI) > 25 on the problem list of patients' charts might improve communication between providers and patients.

Nutrition: The San Francisco Farm to School Report describes a project that aims to bring locally grown fruits and vegetables into school meals.

Educating Providers

This website, see also the links to physical activity and to obesity.

Promoting Community Education

Health fairs and health events work on a small scale. Media advocacy (which requires a newsworthy story) reaches large numbers of people.

Strengthening Individual Knowledge and Skills

DPH Nutritional Services' Feeling Good Project offers multi-lingual classes and educational materials. In addition, the Feeling Good Project operates on all levels of this spectrum.


Here are some suggested interventions from the Steps to a HealthierUS Initiative.

HHS Recommendations, Steps to a HealthierUS San Francisco Interventions or Resources
Alter the food environment by making healthy food the easy, less expensive, and desirable choice.  
Increase the availability of fruits and vegetables by adding salad bars, fruits, and vegetables to school and worksite cafeterias, and by adding fruit to refrigerated vending machines.  
Improve access to fruits and vegetables by encouraging the establishment of community and worksite locations for produce stands and sales.  
Encourage schools and worksites to lower the price of fruits and vegetables to help promote their purchase.  
Implement 5 A-Day programs.  
Conduct community-wide media campaigns to promote healthy food choices.  
Provide “point-of-decision” prompts and supermarket displays to encourage purchase of healthy food items.  
Help to establish social support for making healthy nutritional choices.  
Provide cooking demonstrations on how to prepare foods with less fat, fewer calories, and of appropriate portion size.  
Encouraging restaurants to label heart-healthy menu items.  
Implement hospital and maternity care practices based on the ten steps to successful breastfeeding.  
Implement social marketing and media campaigns with positive breastfeeding campaigns.  
Provide breastfeeding information and services to create a supportive environment for breastfeeding women in the workplace.  
Also see school health  



Poor Diet


Contribution to overall disease burden in SF

Downstream (health consequences)

Upstream causes

What can be done?

Web resources

MEDLINE strategies

Updated May 13, 2004

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