Dear Mayor Lurie and the Members of the Board of Supervisors:
Public health nurses (PHNs) are a vital component of any local government’s health safety net infrastructure. Public health nursing is a specialty practice within nursing and public health, requiring specialized training, knowledge and expertise to address complex health needs. Public health nurses improve population health with a focus on prevention and multiple determinants of health. Public health nurses are Registered Nurses who are advocates, policy makers, planners and clinicians. Public health nurses work collaboratively with department and community partners including community health workers, doulas, social workers, parent educators, physicians, nurse practitioners and more.
Public health nurses serve San Francisco’s most vulnerable populations, providing vital services in all of the following departments:
- MATERNAL, CHILD AND ADOLESCENT HEALTH (MCAH)
- CHILDREN’S ENVIRONMENTAL HEALTH PROMOTION
- COMMUNICABLE DISEASE CONTROL AND PREVENTION
- FAMILY MOSIAC PROJECT / BEHAVIORAL HEALTH
- DISABILITY AND AGING SERVICES (DAS)
- HUMAN SERVICES AGENCY
In April, Department of Public Health leadership announced changes specifically to public health nursing leadership in the Maternal, Child and Adolescent Health division. These changes will severely undermine MCAH programs and are a clear indication that DPH leadership does not recognize or value the critical role of PHNs in MCAH who serve pregnant people and families with young children struggling with mental health, substance use disorders, domestic violence, poverty and homelessness.
The San Francisco Department of Public Health’s Public Health Nurse Professional Performance Committee (PPC) is tasked with the following: to consider constructively and make recommendations regarding the professional practice of nursing, and to consider and recommend ways and means to improve patient care.
In February 2026, Mayor Lurie announced Strong Starts to address health disparities in maternal and infant health outcomes, stating that:
“Supporting pregnant and postpartum women and infants is not just a health priority; it is a moral, social, and economic imperative. A child’s experiences in the first formative year shapes physical, emotional, and cognitive development for the next generation of San Franciscans, influencing outcomes across the life course. Under our administration, San Francisco will concentrate energy, resources, and attention on this critical developmental window—when the right start can change the course of a child’s future.”
Mayor Lurie’s administration and the Board of Supervisors have the opportunity to show that they truly stand behind these words. Removing the professional leadership of Maternal, Child and Adolescent Health, the Department of Public Health section dedicated to working on this issue, is a failure. These professional nurse and physician leaders have the training, experience, and institutional knowledge to address these critical issues now, and the public health nurses they support are key to this effort.
MCAH public health nurses staff key evidence-based and evidence-informed programs, and provide critical assessments and education for pregnant and parenting people and newborns and young children throughout the city. These programs, largely funded by federal grants, have successfully supported:
• Economic stability and growth of young families
• Mothers getting work, housing, starting businesses
• Entrance into prenatal care for women with the highest barriers in the city
• Women experiencing interpersonal violence, a condition that doubles the risk of preterm birth.
• Families at risk of child removal to remain together and to achieve family reunification
Moreover, these changes are illegal. The California State Department of Public Health requires that a local MCAH Director be a qualified health professional who is a board-certified physician in a relevant field, or a non-physician who must be a certified public health nurse (PHN). A local health jurisdiction (LHJ) is also required to have a Director of Public Health Nursing overseeing public health nursing practice. Per the California Code of Regulations, Title 17, Section 1301, public health nursing staff must be supervised by a Director of Public Health Nursing, who must be a qualified public health nurse.
Therefore, the DPH PHN Professional Performance Committee makes the following recommendations regarding the professional practice of Public Health Nursing in the City & County of San Francisco:
- SFDPH public health nurses stand together to demand no more cuts to vital community services, staffing and supports
- SFDPH public health nurses demand no illegal cuts to vital public health leadership and support — reverse the staffing changes that removed legally required positions and their professional qualifications
- SFDPH public health nurses demand the appropriate allocation of the resources needed to support staff and patient safety
- SFDPH public health nurses ask city leaders to recognize the vital role that San Francisco PHNs play in meeting critical health priorities including:
- Reducing and eliminating health disparities in maternal, infant health and child outcomes such as preterm birth
- Addressing the needs of unhoused families and those affected by substance use disorders and mental health conditions
- SFDPH public health nurses demand no more cuts to vital community health clinics and programs.
Sincerely,
The undersigned San Francisco Public Health Nurses, the PHN Professional Performance Committee, clients, and community allies