It’s been two weeks since Grant Colfax stepped into the position of director for San Francisco’s Department of Public Health — and he has no small task ahead of him. The city has long prided itself on being at the forefront of innovative healthcare, be it taking on AIDS in the 1980s with compassion and progressive treatments, or becoming the first city in the nation to open safe-consumption sites (that is, before former-Governor Jerry Brown vetoed the plan).
But guiding the Department of Public Health through its contemporary crises — which range from traffic-related fatalities to overdoses on city streets — takes a specific kind of bravery and willingness to negotiate with politicians and city residents, things few people possess.
Barbara Garcia, it could be said, did have those qualities. Although anyone who leads a city department for eight years will never escape without criticism, Garcia managed to walk the line between advocating for controversial new programs like the street-based buprenorphine prescriptions, and publicly committing to whatever agenda the mayor was currently pushing forward. She also had years of experience with San Francisco’s Department of Public Health, and back in the 1990s was the director of a rural health clinic that served farm workers and their families.
In contrast, Colfax has a very different background. He trained in the internal medicine program at what is now Zuckerberg San Francisco General Hospital, working in Ward 5A, which famously treated gay men at the height of the AIDS crisis. When he graduated, he became an HIV researcher at the department he now leads, before leaving in 2012 to work for the Obama administration. He has the medical background, research experience, and policy knowledge to make data-informed decisions about San Franciscans’ health, and that’s exactly what he plans to do.
“I’m in my first 10 days, so I’m gathering ideas and looking at data,” Colfax told SF Weekly last week. “We look at the data and the tools we have available, and we make decisions on how we can do better.”
But not everything is decided upon internally. Many of the policies the Department of Public Health implements come from outside bodies. Colfax can see City Hall from his office, and as is to be expected of someone appointed by Mayor London Breed — who’s long been an advocate of safe-consumption spaces — Colfax supports them.
“The research around safe-consumption sites is robust. They save lives, and they do not increase substance use,” he said. “Given our current situation in San Francisco, and our legacy of implementing cutting-edge programs that are responsive to the needs of the community, I do think that moving that forward is a key thing that the city should do.”
He’s not opposed to enforcing SB 1045, should it pass locally, something that would expand the qualifications under which someone experiencing severe mental illness could be conserved. But he also sees the value in supporting the Department’s Street Medicine Team, which offers daily support to people living on the streets who need medical care and substance-use treatment.
“My first day on the job, I had the pleasure of visiting one of our street health fairs,” he said. “It was so inspiring to me seeing the street-medicine team working with people in real time, starting people with buprenorphine therapy and providing opioid treatment on demand. Seeing that happen gave me lots of ideas of how we can really scale this work up.”
Colfax’s primary area of expertise, however, is HIV/AIDS, which he credits to those years working in Ward 5A.
“I was so inspired by the approach and the values that the people working in the system had, and their connection and compassion with patients,” he said. “It was really an example of how community and medicine came together during a terrible epidemic, and did the best that we could for people.”
In the years since the epidemic rocked the nation in the 1980s and ’90s, San Francisco’s doctors, advocates, and Health Department have worked tirelessly to get a handle on HIV. With the right medication, people are now living with the disease, not dying from it, and the city’s priorities have changed accordingly.
“We’ve gone from ground zero of the epidemic to getting to zero,” Colfax said, referencing the goal of eliminating HIV transmissions citywide. “I find that so inspiring and exciting. We’re down to 221 new infections, which is the lowest it’s ever been recorded, I believe.”
But there’s still more work to be done. While transmissions have continued to drop, it’s not at an equal rate across populations.
“One of my priorities going forward is focusing on health equity,” Colfax said. “In HIV as with other health conditions, there are serious health inequities among certain populations, particularly communities of color. What’s also concerning is that you take HIV, preterm births, hypertension, smoking rates, incarceration. … You see this ongoing inequity. My goal is to have San Francisco be a place where everyone can have a fair and just opportunity to optimize their health, regardless of the color of their skin.”
Solutions, again, will no doubt come from data — Colfax plans to take a critical look at what is working well, and what isn’t — but he also plans to lean on community expertise to make change happen at a neighborhood level.
And part of supporting those partnerships is maintaining their physical spaces. One of Colfax’s first jobs will be continuing to disseminate a voter-approved $300 million bond to renovate community clinics citywide. He believes the investment in infrastructure can have a transformative effect, not just on the safety of staff and patients, but also the ability to treat vulnerable populations.
“San Francisco General Hospital in 1993 was, well — what it looks like now is very different,” he said, laughing. “I worked in the Urgent Care Clinic at Zuckerberg for years. I just had the pleasure of returning and going to the new clinic, and I can tell you it’s so inspiring seeing what people have done with that. It so resonates with our values. I think that really reflects the community’s commitment to providing the best care possible for people who need it most.”
Looking ahead, Colfax is hesitant to voice what, if any, changes he’ll be making to the department, but his commitment to San Franciscans is clear.
“The combination of community voice and input has really come forward in the department,” he says. “It’s always been there with HIV, but the broader context of doing the work with community has been so key. I’m committed to making sure that those partnerships continue.”
Nuala Sawyer is SF Weekly’s news editor.
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