1. Culture of Health
  2. What We're Learning
  3. Sentinel Communities
  4. Vermont

Vermont

Vermont has a long history of holding health as a shared value; the pandemic further reinforced these ideals. 

See their journey toward health and equity over the last five years.

Vermont, a rural state nestled between the state of New Hampshire to the east and New York to the west, is the second largest state in New England. In the last five years, several factors have advanced health and well being, including statewide action plans, cross-sector collaborations, and community-led initiatives. 

Prior to 2017, Vermont’s Department of Health had incorporated health equity and a health in all policies approach to its work and recognized the importance of social determinants of health. This work has continued to evolve and has strengthened over time. 

Recent events, including the COVID-19 pandemic, have heightened the community’s urgency for incorporating issues of diversity, equity, and inclusion in its work to promote health and well-being. 

There have been growing concerns around mental health and substance use, especially given the devastating effects of the opioid epidemic on Vermont communities. Transportation and the lack of broadband access also remain long-term challenges for residents, particularly in rural areas.

Vermonters have a strong connection to the outdoors and appreciation for their natural environment; which has reiterated the community’s commitment to addressing climate change, but also raised questions about how historic policies have impacted land sovereignty and shaped land ownership—particularly for communities of color.

Overview

Population

624,313

Race/Ethnicity

Median Household Income

Population Living in Poverty by Race

Sources:

U.S. Census Bureau; photography courtesy Flickr user Howard Ignatius, CC BY-NC-ND 2.0.

Notes:

* AINA denotes American Indian Native Alaskan

Downloads
See more sentinel communities
2022 Landscape Report 2017 Portrait Report 2016 Snapshot Report

Each of these Sentinel Community Reports provides insight into the various ways communities across America are working to develop a Culture of Health.

Community Context

Vermont is known for its 67 mountains and peaks, its production of maple syrup, and its colorful foliage.

It is home to a relatively small population of roughly 643,000 residents. As a state with fewer than 10 percent of residents who identify as a person of color, the state has grappled with racial tensions and how to become more inclusive. 

Vermont’s economy is largely driven by the service sector, manufacturing, and tourism. Though agriculture and dairy have long been important industries for the state, there has been a decline in the number of farms over the past 70 years. With a multitude of outdoor tourist activities such as skiing and hiking, the tourism industry is critical, but it is still working to recover from the ramifications of the COVID-19 pandemic. The unemployment rate is low compared to the rest of the country, however there are pockets of the state with high levels of unemployment. 

Vermont has a Republican governor, but the state tends to vote blue, has a mostly Democratic legislature, and has consistently high levels of voter turnout. 

Vermont continues to rank as one of the healthiest states in the nation and has historically been at the forefront of efforts around providing universal healthcare to residents. In 2011, the state passed a law that would establish a single-payer system. Although the implementation of this system was unsuccessful, the state continues to push for reform. Since then, the state established the OneCare system, providing value-based care for residents. 

Vermonters have historically had a strong sense of health as a shared value; and a strong commitment to mitigating the effects of climate change, poor nutrition, and rising rates of childhood obesity.

Community Actions

Vermont’s Journey to Promote Health, Well-Being, and Equity

Five years into the Sentinel Communities Surveillance Project, Vermont’s capacity to promote health, equity, and well-being continues to be led by its Department of Health, but strong cross-sector collaborations and influential nonprofit organizations are also addressing a wide range of issues facing residents across Vermont. Vermont has remained committed to its large-scale state initiatives around health and well-being and has prioritized the collection and use of data to inform decision-making. Local organizations have also implemented various programs and advocated for impactful policies that address individual health and the social determinants of health. A long-standing focus on the social determinants of health has only deepened in Vermont, with additional stakeholders seeing the connection among factors like housing, education, and physical, and mental health. Given Vermont’s fairly homogeneous population, equity discussions were initially focused on income and barriers to health and well-being facing those in more rural areas of the state. In recent years more focus has been placed on racial equity.

  1. 1

    Community Capacity

    ________

  2. 2

    Major Initiatives

    ________

  3. 3

    Health Priorities and Narrative

    ________

  4. 4

    Health Equity

    ________

Community Capacity

________

The Vermont Department of Health (VDH), which has long had a commitment to health equity as a goal within its strategic plan, has clarified its definition of equity and disparities and has expanded its efforts to encompass justice over the past few years.

Vermont’s nonprofit sector has been instrumental in addressing basic needs of residents and raising awareness of the unique needs of rural communities.

Major Initiatives

________

Vermont’s State Health Improvement Plan and the Healthy Vermonters 2020 Plan continue to guide Vermont’s efforts around health and well-being.

Over the past five years, organizations in Vermont have advocated for key pieces of legislation to affect change around health and well-being.

Health Priorities and Narrative

________

The pandemic reinforced an already-strong shared value around health

Health-related language is being incorporated into town plans, and health is increasingly becoming a lens through which non-health sectors view their work.

Health Equity

________

Health equity is now more widely discussed, but there are varying definitions and ideas around how to address it; residents of rural areas continue to be left out of policy conversations.

There has been some momentum to shift formal power structures, as evidenced by work around access to land and support for organizations that serve historically marginalized populations.

Lessons Learned: Where is Vermont Five Years Later?

Over the past five years, Vermont has not experienced dramatic shifts in the way in which it is thinking about addressing health and well-being, but there have been advances in some areas. 

Vermont continues to top rankings as one of the healthiest states in the nation and has been a longstanding leader in promoting health and well-being through its health in all policies approach, focus on climate change, and appreciation of the importance of social determinants of health. Vermont’s journey to promote health and well-being is one that illustrates the importance of narrative and viewing health as a shared value to address social determinants and other drivers of health, and cross-sector collaboration and community engagement to develop and implement more comprehensive, localized solutions.

At the same time, state-level agencies are also actively collaborating to tackle some of the state’s most pressing challenges, including affordable housing and clean energy.

 Other communities can learn from Vermont’s approaches to make these changes— and the challenges encountered—to inform their own journeys. As COVID-19 recovery continues, with historic funding flowing to local communities, future research could consider the ways in which momentum around health, equity, and well-being influences community health narratives and decisions moving forward.

Vermont’s proclivity for working collaboratively, its emphasis on community engagement and its strong sense of identity as a rural state have advanced the state’s ability to promote health and well-being for its residents. However, the rural nature of the state and homogeneity of the Vermont population continues to pose some challenges. 

Facilitators:

  • Longstanding appreciation for social determinants of health

  • Cross-sector collaborations at state and sub-state levels promote health and well-being

  • Robust capacity for data

  • Strong sense of local pride and civic engagement

Barriers:

  • Focus on heavily populated areas of the state can mask needs of those living in rural areas

  • Challenges around data disaggregation by race, ethnicity and geography given small population.

  • Potential for variation in implementation of policies and initiatives across the state, given variation in resources and priorities.

Downloads
See more sentinel communities
2022 Landscape Report 2017 Portrait Report 2016 Snapshot Report

Each of these Sentinel Community Reports provides insight into the various ways communities across America are working to develop a Culture of Health.