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.

Community Actions: A First Look

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.


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.

Going Forward: Questions for Consideration

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 adult 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?