Vermont is about to embark on a new effort to address racial and other disparities in the health care system.
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Over the last two years, the life expectancy of Black men in the United States has dropped by three years. According to the Centers for Disease Control, the racial gap in life expectancy is now wider than it’s been in nearly a quarter century.
It’s one example of how COVID-19 has illuminated and exacerbated racial disparities in the country’s health care system.
"Those of us working in the health equity field called COVID-19 the racism pandemic, because it has resurfaced many of the issues that have existed for a long time." - Dr. Maria Mercedes Avila, Larner College of Medicine at UVM
“Those of us working in the health equity field called COVID-19 the racism pandemic, because it has resurfaced many of the issues that have existed for a long time,” said Dr. Maria Mercedes Avila, an associate professor of pediatrics at UVM’s Larner College of Medicine.
Legislation signed into law by Gov. Phil Scott last month seeks to mitigate those disparities by creating an Office of Health Equity, as well as a new Health Equity Commission.
Health equity experts like Wichie Artu, a data analytics and health specialist, said the commission will give BIPOC Vermonters, as well as Vermonters with disabilities and gay and transgender residents, a stronger voice in public health policy.
“What’s important is that we are providing power to a committee full of organizations who do the work on the ground, who understand the needs of the people,” said Artu, who also serves as vice president of the Windham County branch of the NAACP.
Artu’s pursuit of health equity in Vermont is one reason he and his fiancé purchased a farm in Athens, Vermont last year, shortly after the pandemic began.
Later this summer, Magnetic Fields, as they’ve named the operation, will yield vegetables and herbs used to make a Caribbean broth starter called sofrito.
Artu is part of a growing community of BIPOC farmers in southern Vermont who are building a food
system that honors the cultural diversity of all people who live there. And Magnetic Fields has a specific mission.
“Our whole idea is that we provide a safe and stable environment for a rural BIPOC and queer community that is about farming,” Artu said.
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Cultivating healthy food systems and community gathering spaces for Vermonters from different cultural backgrounds, Artu said, is one way to improve health outcomes in the state. The newly created Health Equity Commission will also push for reforms in more conventional medical institutions.
Back in Burlington, in addition to being a professor at the University of Vermont, Avila is also one of the country’s leading experts on the issue of health equity. Avila has given presentations to more than 150 health care organizations in 27 states, and she’s surveyed more than 10,000 providers across the United States.
“More than 75% of them actually don’t know the history of systemic racism and racial disparities, which is not unique to the health care field,” Avila said.
Ignorance of the history of racism and its legacy in the health care system is one reason, according to Avila, that people of color have trouble accessing medical care and get poorer outcomes when they do.
“Provider biases, lack of training around culturally responsive care, lack of training around how to use interpreters … there are many different areas in this field of health equity,” she said.
Avila says the Health Equity Commission, which will advise the Office of Health Equity, could help medical institutions evolve care in ways that mitigate those inequities.
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“We have extensive research showing that if your provider mirrors your cultural background, for example speaks the language of the patient that they’re going to see, shares cultural beliefs with the patient that they see, health outcomes are going to be better,” Avila said.
Many providers have already begun their own personal evolution in the field of health equity, including Dr. Rebecca Jones, a dermatologist who practices in Brattleboro.
“It’s kind of like you get a super power, you know? It’s like you put on a different set of glasses and suddenly you can see things you couldn’t see before,” Jones said.
"I guess one of the dilemmas is that -- I can speak this way because I'm a doctor myself -- we have a problem with humility sometimes, and it takes humility to do this work." - Dr. Rebecca Jones, MD
Jones said the blind spots doctors have before they discover those magic glasses can have very real consequences for patients of color. It’s something she’s seen personally in the field of dermatology.
“Because we have blanket recommendations, as if everybody’s skin responds to sun the same way, which always bothered me, but it just doesn’t make any sense,” Jones said.
Jones said it’ll take some doing to educate the provider community.
“I guess one of the dilemmas is that -- I can speak this way because I’m a doctor myself -- we have a problem with humility sometimes, and it takes humility to do this work,” Jones said.
The work also requires a wider view of how doctors and other providers define health, according to Dr. Andrea Green, who runs the New American Clinic at the UVM Children’s hospital in Burlington.
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Green is in the process of re-writing the American Academy of Pediatrics position statement on poverty. She said racial disparities in health care are often a product of racial disparities in wealth, housing and education.
“We ask people to live on such a little amount of money; it’s just not possible. And if you live in that kind of stress all the time, you can’t be healthy. You can’t do any of these other things, you’re just constantly in this stress,” Green said.
Have questions, comments or tips? Send us a message or get in touch with reporter Peter Hirschfeld @PeteHirschfeld.
Correction 6:18 p.m. 6/23/2021: Dr. Andrea Green is re-writing the American Academy of Pediatrics position statement on poverty, not racism, as a previous version of this story stated.
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