Representatives of a state health equity advisory group came to the Statehouse on Wednesday morning to ask for what they had advocated for two years ago: dedicated funding and staff to address health disparities among different groups of Vermonters.
Members of the Health Equity Advisory Commission, created through legislation in 2021, sought help from lawmakers during a joint session of the House and Senate health committees. They want to secure a yearly appropriation of $1.57 million, starting with the 2024 fiscal year budget, which has passed the House and is now in the Senate.
Three groups that intersect with each other have been found to face worse health outcomes and greater challenges in accessing health care: Vermonters of color, Vermonters who are not heterosexual or cisgender, and Vermonters with disabilities. This is also true across the country.
Commission members told lawmakers they need dedicated and consistent funding to create the Office of Health Equity, which, according to the law, was to be operating by January 2023.
“We have a great vision. We thank you for entrusting us to bring this back to you, but now we need the resources to get it done,” Mark Hughes, director of the Vermont Racial Justice Alliance and commission chair, said in his presentation to lawmakers.
Beginning to truly address health disparities would require the creation of an office within state government that is independent of any particular state agency and can work with all of them, said commission member Kristen Murphy, director of the Vermont Developmental Disabilities Council.
While one concept considered was to house the office within the Vermont Department of Health, the commission doesn’t believe that will be effective. The department has been working on its own health equity initiatives, funded by a large grant from the U.S. Centers for Disease Control and Prevention, which is time-limited.
Disparities in health outcomes are the result of systemic inequities across a wide variety of sectors, including housing, education, economic development, transportation and law enforcement, Murphy and Hughes said.
“We are absolutely sure that what is required to achieve the transformation that the Legislature is looking for is a whole of government approach,” Murphy said. “We feel that focusing only on the health component is so far downstream that it’s not going to bring the success that you are looking for.”
The legislation that created the commission was approved in May 2021, the same month that a joint resolution declared that, “racism constitutes a public health emergency in Vermont.”
The health department had reported the previous December that although Vermonters who are Black, Indigenous and people of color make up only 6% of the population, they made up 18% of the state’s Covid-19 cases within the first six months of the outbreak.
“I think more than ever when the pandemic came we began to see these disparities that we have been talking about, the impact of systemic racism, really more than ever,” Hughes said. “They were not new. They were just being revealed more clearly”
The 30-member commission was charged with a long list of substantial tasks: develop a structure and budget for the office, eradicate health disparities, amplify the voices of affected communities, and monitor and advise state agencies and the Legislature about the impact of current and emerging policies and practices. The fiscal year 2022 budget bill included a one-time $180,000 allocation to support the work.
Managing a large board with such a broad mandate without dedicated administrative staff has been challenging, according to Hughes and Murphy. A number of the commission’s members are juggling jobs and family commitments, and have not been able to participate fully due to the low $50 per diem payments specified in the law.
With a larger budget, the commission would hope to hire a director for the Office of Health Equity by January 2024 and have the office staffed by that July. Once work gets going, they would likely need more money, Hughes told lawmakers.
“What we are aiming towards is a uniform approach to eradicating these disparities across state government,” Hughes said. “Literally, we want to accomplish the mission that you charged us with.”
Sen. Ginny Lyons, D-Chittenden Southeast, chair of the Senate Health and Welfare Committee, told the commission members that her committee would discuss their funding request with the Senate Appropriations Committee
Rep. Topper McFaun, R-Barre Town, wondered why the effort doesn’t also focus on low-income people in general, who also suffer from health disparities.
Hughes responded that the efforts of the new office would also assist that group, even though that is not the explicit focus. For example, a majority of people of color in Vermont are poor, but the majority of poor people in Vermont are not people of color, he said.
“When we do more for some who have historically not benefited, it doesn’t mean we do it at the loss of others,” Hughes said. “When we create policy that helps those folks who are the most vulnerable, it ends up helping all of us.”
