The Vicious Cycle of Poverty and Unmet Community Health Needs in San Francisco’s Tenderloin (TL) Neighborhood: Solutions Based on Stakeholder Perceptions

Abstract

A vicious cycle has arisen in San Francisco’s Tenderloin (TL) neighborhood, in which poverty contributes to significant health disparities, thwarting optimal health outcomes, thus further worsening the underlying poverty which takes on a generational and urban character. TL residents face core socioeconomic and public health challenges with regard to the following themes: access to and coordination of care and services; food security (including healthy eating and active living); housing security; safety from violence and trauma; social, emotional, and behavioral health; poverty; and infrastructure. Essential deficiencies in these domains individually and together worsen the community’s health outcomes. This Capstone examines these problems, themes, root causes and what factors make them so persistent, utilizing interviews of community stakeholders and published literature to evaluate these issues in the TL and broader San Francisco County. It also links these findings with efforts of SF-based organizations and initiatives such as the 2019 San Francisco Community Health Needs Assessment (CHNA), considering them in the context of the socioecological model (SEM), and producing a Tenderloin Community Needs Assessment (TL CNA). These results clarify that the public health impact of these unmet community health needs has been severely detrimental for the long-term health of TL residents, including children, giving rise to a self-perpetuating vicious cycle of poverty. These determinations and themes are at the root of the TL’s core problems. To conclude, recommendations and solutions were stated by stakeholders and analyzed in depth, to help address and remedy the primarily low-income, minority population’s unmet public health needs