Public health principles are based on promoting dignity, equity and compassion for all. San Francisco has made great strides towards "Getting to Zero" HIV infections, deaths, and stigma. However, we face new challenges with persons who inject drugs (PWID), and increases in substance use disorder, mental illness, and homelessness. Residents and visitors are concerned about (a) an increase in people injecting drugs in public and (b) an increase in discarded syringes on the streets of San Francisco. Some have asked whether syringe access programs are distributing too many syringes, and whether this poses a health risk to the general public. This brief reviews the science behind syringe access programs and how they protect the public’s health. To protect the public’s health, San Francisco’s deploys a collective impact approach to (a) reduce syringe sharing, infection, and disease prevalence (by syringe access); (b) reduce contact with discarded syringes (by syringe disposal and recovery); and (c) prevent and reduce needlestick injury harms (occupational safety and health).

public health, population health, decision analysis, causal inference, program theory, Bayesian networks, epidemiology, decision quality

For transforming organizations and community health, the San Francisco Department of Public Health, Population Health Division has embraced population health lean—an innovation and performance improvement management system based on the Toyota Production System (lean), collective impact methods (e.g., Results-Based AccountabilityTM), and human-centered design. We cover lean, collective impact, human-centered design, making quality decisions, building effective teams, and leading organization transformations. Our core values include humility, respect for people, teamwork, embracing challenges, genchi genbutsu (“go and see” to understand), and kaizen (continuous improvement).