Building a Culture of Health in Vermont

It takes a village to create a fair and just opportunity for health.

See Vermont's approach!

No individual solution will do: we must all work together, at all levels and all sectors, to build a culture of health in Vermont.

As Vermonters, we take great pride in our strong communities and natural places. We share a common goal: to ensure that our state continues to be one of the healthiest and best places in the U.S. for all of us to live, learn, work and play.

Read more about the Vermont approach to creating cross-sector action and accountability for health

Health Equity

We recognize that there are many factors that impact health—often we focus on access to care and individual behaviors. But change in these alone will not create fair and just opportunities for health for all. When we bring health into the conversation across the board, when we talk about how housing, transportation, food availability and other social determinants impact health; when we talk about who is involved in decision making and how policy impacts those determinants; when we talk about how systemic racism, class oppression and gender inequality have impacted those policies—then we begin to see the connection to health equity.

How are we working on all levels?

  • Our commitment to health equity shows in our Vision & Mission, and is the lens through which we are renewing our health assessment and improvement plans.
  • The Health in All Policies Task Force brings the conversation to the policy level.
  • Partners in multiple sectors have identified how their daily work impacts health—see the “Health and…” section below for a growing index of best practices and ongoing projects.
  • The Total Health Expenditure Analysis is a project that analyzes Vermont’s health spending across sectors.

Health in All Policies Task Force

Vermont already has many examples of a Health in All Policies (HiAP) approach. The challenge and opportunity now is to maximize the impact through system-wide changes supported by a cabinet level Task Force empowered to utilize the authority and tools of government.

Health in All Policies Scorecard

Read more about the Health in All Policies Task Force

The Health in All Policies Task Force is a cabinet-level body established by Executive Order No. 7-15 to identify how agency policies, programs and budgets can improve the health of Vermonters, especially vulnerable populations. Members of the Task Force are looking at the practices within their agencies and working to coordinate across agencies around issues of healthy communities.

The Task Force developed a Health and Equity Framework for creating economically and socially vibrant communities that build upon the shared values of equity, access and affordability. The framework identified potential areas of impact and domains for measuring successes. The Task Force is developing a shared Dashboard to demonstrate the successes and track the work of various partners in contributing to health and equity.

Health in All Policies Annual Reports

The Health in All Policies Task Force provides an annual report to the governor on–

  • Potential opportunities to include health criteria in regulatory, programmatic and budgetary decisions
  • Promising practices in other jurisdictions to identify opportunities for innovation and coordination across sectors that include consideration of potential positive and negative health impacts of decisions
  • Evidence-based actions and policies to improve the wellness of state employees across state government, including healthy food procurement policies

The Task Force will seek to enhance health while advancing our other goals, such as protecting natural resources and agricultural lands, increasing the availability of affordable housing, improving air and water quality, improving infrastructure systems, promoting public health and active lifestyles, planning sustainable communities, increasing educational attainment and meeting the state’s climate change goals. 

Healthy Food Procurement Toolkit

The state has the “power of the purse” to promote the purchase, and offering, of healthy local foods. Vermont has developed standards to be used whenever food is offered at cafes and cafeterias on state property or at state-funded meetings, conferences, and events that are paid for with state or federal dollars (in accordance with the Department of Finance and Management Policy 4.0 Department Provided Food and Refreshments).

The Healthy Food Standards for State Government provides a basic description of standards developed to comply with 29 V.S.A. § 160c.

Implementing Vermont's Healthy Food Standards offers suggestions regarding the various options for implementation and some tips from the field.

Best Practices for Population Health by Sector

Identify the evidence-based options for other sectors to advance their mandates while simultaneously investing in population health improvement.

Best Practices in Agriculture
Best Practices in Energy
Best Practices in Housing
Best Practices in Land-use and Community Development
Best Practices in Natural Resources
Best Practices in Transportation

Read more about the work and resources in each sector:

Agriculture and Food

Eating healthy food, especially a variety of fruits and vegetables, is essential to promote and maintain good health. Local, regional, and state polices can help people access healthy, local food and protect our food system.

  • Farm to School helps Vermont schools engage students in their local food system by incorporating local food and farm education into their cafeterias, classrooms and communities.
  • Farm to Plate is Vermont’s food system plan being implemented statewide to increase economic development and jobs in the farm and food sector and improve access to healthy local food for all Vermonters.
  • Regional Food System Plan for Vermont’s Northeast Kingdom: This plan represents an attempt to develop a vibrant agricultural economy and food system in the region through a regional planning process that builds on the strengths of regional and statewide planning, as well as local and decentralized planning. The goal of this plan is “to drive the development of new and more diverse agricultural activity and to develop a comprehensive strategy to stimulate this innovative food system sector for Caledonia, Essex, and Orleans Counties”.
  •  PDF iconBest Practices in Agriculture: The Best Practices are a set of evidence-based guidelines and activities that connect initiatives of each state sector to population health.
Education

Education and health go hand in hand. People with more education have better health outcomes. What this tells us from a policy perspective is that schools of all levels have the ability to improve population health directly.

Vermont School Wellness Policy Guidelines:  The Vermont School Wellness Policy Guidelines and Implementation resource was developed using the Local School Wellness Policy Final Rule and USDA’s Smart Snacks Nutrition Standards for all Foods Sold in Schools, as required by the Healthy, Hunger-Free Kids Act of 2010. Each local education agency participating in the National School Lunch Program or the School Breakfast Program is required to develop and implement a local wellness policy. The wellness policy is guides the agency to create supportive school nutrition and physical activity environments. The Policy Guidelines were developed through collaboration between the Agency of Education, Department of Health and Agency of Agriculture.

Energy

We need energy to keep us healthy; energy is used for cooking, heat, transport, medical care, and more. However, not all energy is safe and affordable; fossil fuels can harm our health from their production to their use. Energy efficiency programs like weatherizing homes and using renewable energy improve the health of people and the environment.

PDF iconBest Practices in Energy: The Best Practices in Energy are a set of evidence-based guidelines and activities that connect initiatives of each state sector to population health. These cross-sectoral activities demonstrate an intentional adoption of a health-in-all-policies framework. The Best Practices are a product of the Public Service Department, developed with technical assistance from the Health Department and the Vermont Health in All Policies Task Force. The Best Practices align with the Total Health Expenditure Analysis as a governmental tool to measure and create a culture of health.

Housing

Safe and adequate housing is essential to people’s health and wellbeing. Health and housing policies are designed to ensure people of all ages are not exposed to toxins in their living spaces, or to provide access to essential services from housing sites.   

  • Support and Services at Home (SASH) coordinates the resources of social service agencies, community health providers and nonprofit housing organizations to support Vermonters who choose to live independently at home.
  • Indoor Air Quality Studies have shown that air pollution in our homes can be more of a health concern than air pollution outside. Indoor pollutant levels may be many times higher than outdoor levels. Learn more about how to address indoor air quality at this site.
  • Lead Abatement The Asbestos and Lead Regulatory Program works to protect Vermonters from exposure to asbestos and lead when maintaining, renovating, or demolishing buildings and when cleaning up after a fire, flooding, or storm damage. The program strives to prevent exposure of the public to asbestos and lead in workplaces, buildings, and housing associated with asbestos or lead abatement activity.
  •  PDF iconBest Practices in Housing: The Best Practices are a set of evidence-based guidelines and activities that connect initiatives of each state sector to population health.
Land Use Planning and Community Development

Community planning is essential to creating places that: support active living (walking, biking, recreation); expand access to healthy and affordable foods; have tobacco and substance free spaces; and protect people’s safety, air and water quality – all of which are essential for good health. “Healthy community design” changes the physical environment, community infrastructure and local policies to create such an environment. Healthy community design means planning and designing communities to make it easier for people to live healthy lives.

  • Vermont Healthy Community Design Resource, Active Living & Healthy Eating provides an overview of the town planning process and examples of how to crate communities that support active lifestyles and access to healthy food.  
  • Health Impact Assessment (HIA) is a process that helps evaluate the potential health effects of a plan, project or policy before it is built or implemented. Learn more about Vermont’s HIA work at this site.
  • East Central Vermont Plan: This is a regional plan to support planning efforts that integrate housing, land use, economic and workforce development, transportation, and infrastructure investments in a manner that empowers jurisdictions to consider the interdependent challenges of: (1) economic competitiveness and revitalization; (2) social equity, inclusion, and access to opportunity; (3) energy use and climate change; and (4) public health and environmental impact.
  • ECOS Sustainability Project: The ECOS Project, “A Sustainable Future for Chittenden County,” represents a once-in-a-generation opportunity to engage citizens, organizations and municipalities in a conversation about the future of our communities and the region as a whole. The plan is an update to the Chittenden County Regional Plan, Metropolitan Transportation Plan, and Comprehensive Economic Development Strategy.
  • Best Practices in Land-use and Community Development: The Best Practices are a set of evidence-based guidelines and activities that connect initiatives of each state sector to population health.
Natural Resources

Respect. Protect. Enjoy. The Vermont Agency of Natural Resources promotes the sustainable use of Vermont's natural resources, protects and improves the health of Vermont's peoples and ecosystems, and promotes sustainable outdoor recreation. Vermonters are proud of our state's beautiful natural resources. Parks, forests, wildlife, lakes, rivers; we have many opportunities for fun, physical activity, and improving mental health. The economic benefits of natural resources are also important to public health.

  •  PDF iconBest Practices in Natural Resources: The Best Practices are a set of evidence-based guidelines and activities that connect initiatives of each state sector to population health.
Transportation

A connected network of adequate, safe, and accessible transportation options is essential for people of all ages and abilities to access goods and services, including education, jobs, food, health and dental care, recreation and social opportunities.  Local, regional, and state polices that ensure all modes of transportation are included in all transportation and development projects will support good health. 

  • Complete Streets ensures streets safely accommodate all transportation system users, regardless of age, ability, or their preferred mode of transportation, including walking, biking, driving, or the use of transit. Learn more about Vermont’s Complete Streets efforts at this site.
  • Vermont Bicycle and Pedestrian Program: Learn about Vermont’s Bicycle and Pedestrian Program, whose goal is to provide safe and convenient facilities for those Vermonters who desire alternative transportation opportunities.
  • PDF iconBest Practice in Transportation: The Best Practices are a set of evidence-based guidelines and activities that connect initiatives of each state sector to population health. These cross-sectoral activities demonstrate an intentional adoption of a health-in-all-policies framework. The Best Practices are a product of the Agency of Transportation, developed with technical assistance from the Health Department and the Vermont Health in All Policies Task Force. The Best Practices align with the Total Health Expenditure Analysis as a governmental tool to measure and create a culture of health.

Total Health Expenditure Analysis

The Total Health Expenditure Analysis is a tool that can be used to quantify the investments by non-health sectors in efforts that can protect and promote health. This tool meets the mandate of the Health in All Policies Task Force to report on how its budget decisions impact health.

Read more about the Total Health Expenditure Analysis

Complementing the Health in All Policies approach, Vermont is involved in a project to analyze what we spend on health as a state—not simply individual health care related expenditures. Clinical care is only a small contributor to our overall health and wellness. Other factors—such as social, environmental, and individual behaviors—influence both our health and our ability to make healthy choices. We need to better understand current health-related investments across sectors and rebalance health spending.

Guiding Questions

  • What are we spending now?
  • What is our spending getting us?
  • What happens when we change the way we spend?

Read about the Total Health Expenditure Analysis project in brief

Recommendations will be provided to non-health state agencies to integrate health-related metrics into their existing performance dashboards. These model dashboards will foster shared accountability for health across sectors.

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