Special Section: Ethical Health Policy
FIXING OUR DYSFUNCTIONAL SYSTEMS AND INSTITUTIONS IS CRITICAL TO IMPROVING OUR PUBLIC HEALTH Mihal Emberton, MD One in four US adults suffers from depression or anxiety 1,2. The ubiquitous nature of these mood symptoms points to systemic and institutional dysfunction as the likely etiology rather than individual dysfunctional brain chemistry. The World Health Organization agrees, with their identification of “burnout” as a global, occupational phenomenon.3 Additionally, our burgeoning understanding of adverse childhood experiences4 and trauma-informed care5 also highlight our realization that dysfunctional systems and institutions negatively impact our mental health, physical health, and wellbeing, and are thus global public health crises.6,7 San Francisco is a remarkable city, and I am grateful and honored to live here. However, like any other system or institution, San Francisco suffers from unconscious biases and inconsistencies within our City General Plan which inflict discrimination and injustice upon our citizens, subsequently harming their health and wellbeing. Dr. Hahn, anthropologist and epidemiologist who received the 2013 Lifetime Contribution Award for Outstanding Dedication to Excellence in Behavioral and Social Science from the CDC,8 and colleagues emphasize that “The historical denial of the civil rights of racial and ethnic minority populations…indicates that civil rights can be a powerful social determinant of health. Deprivation of civil rights has been a prominent factor in the poor health of Black people in the United States…Public health benefits depend not only on the existence of civil rights and regulations, but on their implementation, including their enforcement. Unless implemented, civil rights are promises without benefit. While the scope of efforts to protect civil rights has greatly expanded in recent history, evidence presented here and elsewhere (Reskin, 2012; Smith, 1999; Chemerinsky, 2002) shows that enforcement of civil rights has been uneven and incomplete, and, at least in domains of health care, education, and housing, resistance to civil rights laws and their implementation persists.”9 WWW.SFMMS.ORG
Civil Rights Violations permitted by SF City General Plan A citizen repairing a blighted fence while listening to music is reported to the City by a neighbor complaining that “the resident at this address has been consistently doing construction and playing loud music from 10am-6pm/7pm most days of the week. I would like to request the music volume be lowered or turned off. I can hear it in my apartment all day." This complaint is reported to the Department of Building Inspection for investigation. To any reasonable person, neither “consistently doing construction” nor ‘playing loud music during the day’ imply nor provide evidence of a violation of the City General Plan, highlighting a lack of protection from unlawful and/or unreasonable searches and seizures, a civil right protected by the 4th Amendment of the Constitution. A citizen following 11 SF building codes for removal of blight is issued a notice of violation because "a complaint investigation has revealed the installation of a new fence on a corner lot without the benefit of a building permit.” To any reasonable person, conflicting codes, such as the removal of blight conflicting with new construction requirements, is evidence that inconsistencies exist which violate citizens’ rights to equal protection under the law, protection from extortion, and protection from coercion. The California State Office of Planning and Research requires cities to recognize and remedy such inconsistencies at the origin, rather than giving one element precedent over another, in order to achieve an integrated and internally consistent City General Plan.10,11 A citizen follows corrective actions to “obtain building permit with plans and Planning Department Approval [for a four-foot fence]” but is later mandated to ‘remove an unrelated trellis from the front setback before the four-foot fence permit can be approved.’ To any reasonable person, the expansion of “corrective action,” such that a four foot fence initially needing permit review for approval later requires the prerequisite of removal of a separate structure, is evidence of extortion, coercion, discrimination, and lack of equal protection under the law. During the permit review process, a city agency requests continued on page 18
JANUARY/FEBRUARY/MARCH 2022 SAN FRANCISCO MARIN MEDICINE
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