State of Vermont

With an activist history and long-standing commitment to health, Vermont consistently ranks one of the healthiest states in the nation.

Vermont has led the nation in promoting efforts to improve health care access, equity, and affordability. The state is a long-established leader in forging consensus for a universal health care system, developing a promising health services model to manage chronic diseases, and promoting physical fitness as a shared value and a way of life for its residents. These efforts have produced success stories and cautionary tales. In addition to continued efforts to transform health care services, Vermont recently enacted a health in all policies approach, which incorporates health considerations into decisions involving cross-sector partners and state and local agencies.

Vermont is on the whole wealthier, better educated, and significantly healthier than most of the country, with 94% of residents insured, compared to 86% of the nation. Obesity rates are lower (25%, compared to 30% nationwide), and only 16% of residents smoke, compared to 18% nationwide.

Overview

Population and Demographics

Population: 626,358

SOURCES:
City-Data.com; U.S. Census Bureau; photography courtesy Flickr user Howard Ignatius, CC BY-NC-ND 2.0.

Context and Actions

Community Context and Challenges

Health outcomes vary by educational attainment; residents without a college degree are less likely to have insurance and report poorer health.
Unmanaged chronic disease (e.g. asthma, congestive heart failure, diabetes, and coronary artery disease) contributes to escalating health costs.
The state’s ambitious plan to launch a single-payer system—the first of its kind—was abandoned in 2014, citing higher-than-expected tax revenue requirements.
Despite better-than-average health outcomes statewide, rural areas like Essex County have lower rates of insurance, limited access to healthy foods and opportunities for activity, and a shortage of health care professionals, compared to more populous areas like Chittenden County, revealing a limited reach of reforms.
Substance abuse, especially opioid and heroin use, is on the rise; compared to the nation, Vermont has higher levels of illicit drug use among adolescents and adults.

SOURCES:
Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. National Survey on Drug Use and Health (NSDUH), 2013 and 2014.

Taking Action

In a state where many view health care as a right, not a privilege, leaders are striving to achieve health equity by expanding access to affordable services.

Vermont’s efforts to transform health care and establish a mandate to incorporate health in all policies exemplify its commitment to health and well-being. Building on nearly 30 years of experience, Vermont has expanded access to health coverage and reduced chronic disease in the state. In addition to enacting bold legislation, Vermont is leveraging federal programs and creating public-private models to expand access to care.

NOTE:
These baseline reports, created in 2016, track community programs and initiatives in their early stages and measure initial progress only. Future reports will provide more in-depth insights and analysis into this community's efforts to build a Culture of Health.

Shared Values

The state has a long history of progressive causes. It was the first state to abolish slavery and fund public schools, and more recently, Vermont showed interest in advancing models for universal healthcare coverage and increasing the minimum wage.

Northeast Kingdom Farm to School Program

The Northeast Kingdom Farm to School Program promotes a sense of community and collaboration between schools, farms and communities to help rural schools build gardens, access food from local sources and provide education on nutrition and agriculture.

Healthy People in Healthy Communities

The state department of health awards 2-year grants to community-based boys and girls clubs, youth coalitions, family centers, hospitals, and health and rehabilitation providers. Funds support cross-sector, community-based chronic disease prevention strategies that target alcohol and drug abuse, nutrition and physical activity, and tobacco control.

Blueprint for Health Initiative

The Blueprint for Health Initiative is a state-led effort to help providers address the medical and social needs of residents through patient centered medical homes (PCMH) and increased integration of medical care and social services. The initiative includes a network of evidence-based practice facilitators, heads of community health teams and project leaders who work with providers to improve disease prevention through care coordination in counseling. They also assist with increased integration of medical care and social services.

Going Forward

Additional surveillance, data, and information gathering, analysis, and reporting will examine the extent to which Vermont’s policy environment is influencing its long-standing efforts to expand coverage, reduce costs, and improve access to initiatives that aim to prevent and manage chronic disease. Future reports will examine the impact of new initiatives to replace the state’s signature single-payer health plan and whether new leadership in the Governor’s office will significantly alter the priority the state has traditionally placed on health care access and equity.

Specific questions include the following:

To what extent has the state’s commitment to health care access and equity changed because of the highly publicized problems with the online health insurance exchange?
How effective has the Blueprint for Health been in preventing and managing chronic disease, beyond lower expenditures for medical care?
How does Vermont intend to address disparities in health and health care among many rural residents who have less access to physicians, physical activity, and healthy foods?
Does the priority that Vermonters place on being environmentally friendly position them well for collective action on health?
How can successful health care systems and financing reforms help Vermont to address significant, emerging public health problems, such as the striking increase in incidence of illicit drug use among adults and youth in the state?
How will public health priorities change as a result of climate change, which will affect seasonal tourism, employment, revenue, and the economy in the near future?
What can we learn about health care reform from Vermont that can be generalized to other states that have large rural areas?
Beyond the state government, what organizations are engaged in activities that contribute to the state’s culture of health?