State Health Assessment Plan • Healthy Vermonters 2020

December 2012 Contents December 2012 Introduction Behaviors, Environment & Health From the Health Commissioner ...... 1 Alcohol & Other Drug Use ...... 22 Introduction ...... 2 Tobacco Use ...... 24 Dear Vermonter, State Assets ...... 5 Nutrition & Weight ...... 26 Our state has a long history of improving public health. Vermont was named the healthiest state Reader’s Guide ...... 6 Physical Activity ...... 28 in the 2012 America’s Health Rankings. We have risen steadily in those rankings – from 20th in 1990 and 1991, to #1 healthiest for the fourth year in a row. Data Sources & References ...... 7 Injuries ...... 30 Environmental Health ...... 32 Our strengths include some of the social determinants that are at the foundation of good health: a high rate of high school graduation, higher median household income, lower unemployment, A Healthy Lifetime few violent crimes, nearly universal health insurance coverage, a ready availability of primary care Family Planning ...... 8 Diseases & Health Conditions providers, and the lowest rate of low birthweight babies. Vermonters are among the most physically Maternal & Infant Health ...... 10 Heart Disease & Stroke ...... 34 active Americans, fewer people smoke, and we have a low rate of infectious disease. Early Childhood Screening ...... 12 Cancer ...... 36 But there are challenges ahead. With this publication of Healthy Vermonters 2020, we begin our third Older Adults ...... 13 Diabetes ...... 40 decade of engaging policymakers, government, health and human services professionals and the Respiratory Disease ...... 42 public in setting, measuring and working to achieve public health goals for the next 10 years. Providing for Better Public Health Arthritis & Osteoporosis ...... 44 Thanks to the dedicated focus of the many Vermonters involved in this undertaking, we present in Access to Health Services ...... 14 HIV, AIDS & STDs ...... 46 the following pages our Healthy Vermonters goals – with information, maps and data from an array Immunization & Infectious Disease ...... 16 of sources that show where we are at the start of this decade, and where we aim to be by 2020. Oral Health ...... 18 Public Health Preparedness . . . . 48 Please join us in working for a healthier Vermont, Mental Health ...... 20 2010 Report Card ...... 49

Healthy Vermonters 2020 is also available at: healthvermont.gov Vermont Department of Health 108 Cherry Street, PO Box 70, Burlington, Vermont 05402 Harry Chen, MD Commissioner of Health

PHOTOS — front cover: Owls Head at Groton State Forest, Marshfield • by Kallie Huss back cover (clockwise from top left): Calvin Coolidge Homestead • Jim Eaton; Arcadia Brook Farm, North Ferrisburg • Karen Pike; Burke Mountain • Dennis Curran; home flower garden • David Grass; Burlington • Karen Pike; Burlington • Karen Pike; home vegetable garden • David Grass; Lake Champlain, Sand Bar State Park • Dennis Curran

1 Introduction Grand Isle Grand Isle • How Rural is Vermont? Franklin Orleans Franklin Orleans While most agree that Vermont is a rural state, defining “rural” can be challenging. #5 #12 #13 Essex #4 #12 #7 Essex #14 #14 The U.S. Cenus Bureau considers rural to be any area that is not urban. For an area to • Healthy Vermonters 2020: The State Health Assessment be urban, there must be 2,500 or more residents. By this measure, 61 percent of The Health Disparities of Vermonters, published by the Vermont Department of Health Lamoille Lamoille Vermonters live in rural areas. in 2010, offers an in-depth assessment of the differences in health status among the #7 #5 Chittenden Caledonia Chittenden Caledonia people of our state. The report details how our health is shaped by factors well beyond Various federal government agencies recognize more than 20 different definitions #1 #10 #1 #11 genetics and health care. Income, education and occupation, housing and the built for rural. Depending on the specific definition, some Vermont communities could be environment, access to care, race, ethnicity and cultural identity, stress, disability and Washington Washington #2 #3 considered rural or not, based on proximity to Chittenden County. By one definition, depression are “social determinants” that affect population health. Vermont is the most rural state in the nation based on the fact that there are no towns Addison Addison with more than 50,000 residents. One county, Essex, is considered “frontier.” By another Also since 2010, the annual County Health Rankings by the University of Wisconsin #3 Orange #2 Orange definition, all of Chittenden, Franklin and Grand Isle counties are considered “non-rural” Population Health Institute and the Robert Wood Johnson Foundation, demonstrate #9 #8 because they are part of the Burlington-South Burlington Metropolitan Statistical Area that where and how we live matters to our health. Although Vermont has been ranked defined by the federal Office of Management and Budget. time and again, and by many measures, as one of the healthiest states, a closer look at how health factors and outcomes vary across the state tells the more complex story: • An Aging Population Even in the healthiest state, we are not all equally healthy. Rutland Windsor Rutland Windsor Vermont is aging faster than other states. In 2010, the median age of Vermonters was #11 #4 KEY: #13 #9 KEY: 42 years, compared to the national median of 38 years. And the state/national age gap The purpose of this state health assessment – Healthy Vermonters 2020 – is to prioritize Healthiest #1-4 Healthiest #1-4 is widening, from about two years in 2000 to four years in 2010. More than one-third of goals and objectives for the decade, and provide the baseline data so we can track our Vermonters (37%) are between the ages of 40 and 64. The median age of Vermont men progress into 2020. To do so, we have drawn upon these two reports and a broad array Healthier #5-7 Healthier #5-7 is just over 40 years, and the median age of women is 43. of data sources (see Reader’s Guide and Data Sources, pages 6-7), and engaged state Bennington Bennington government, health and human services professionals and the public to provide their #8 Healthy #8-10 #10 Healthy #8-10 • Growing Diversity thoughtful review and comment. Windham Windham Vermonters come from a wide range of racial, ethnic and cultural backgrounds, #6 #6 including Black Americans and American Indians, many of whom are descendants of Less Healthy #11-14 Less Healthy #11-14 • A Small State, More or Less Well Populated the original Abenakis. Many more recent residents come from Africa, the Middle East, According to the 2010 U.S. Census, Vermont is home to just over 625,000 people. Asia and Eastern Europe – and a Hispanic/Latino population from Mexico, Cuba and Our land mass is small – 9,216 square miles – and averages 68 people per square mile. the Americas. Composed of 14 counties with 255 municipalities (towns, cities, unincorporated areas Health Factor Rankings, by County Health Outcome Rankings, by County and gores), we are governed at the state and local (but not county) level. More than Rankings are based on a combination of health behavior measures (tobacco use, Rankings are based on a combination of morbidity measures (poor or fair health, While Vermont’s racial and ethnic minorities, at 6 percent of the total population, are one-quarter of all Vermonters live in Chittenden County. Rutland County, the next most diet/exercise, alcohol use, sexual activity), clinical care measures (access, quality), poor physical health days, poor mental health days, low birthweight) and proportionately small compared to the rest of the U.S., these populations are growing populous, has less than one-tenth of the state’s population, and Washington County, socio-economic factors (education, employment, income, family/social support, mortality (premature death). at a faster rate than the population overall. In 2010, Blacks or African Americans made where the state capital Montpelier is located, is a close third. The counties that make up community safety) and environmental measures (air quality and the built up 1.1 percent, Asians (Chinese, Filipino, Japanese, Korean, Vietnamese), 1.4 percent, the Northeast Kingdom – Caledonia, Essex and Orleans – are the least populated and environment). and Hispanics (Mexican, Puerto Rican, Cuban), 1.6 percent. Not included in these the most rural. County Health Rankings 2012 • data 2002-2010 County Health Rankings 2012 • data 2002-2010 statistics are an estimated 5,000 undocumented people, mostly Mexican farm workers, according to the Federation for American Immigration Reform.

2 3 • Many Languages Spoken However, 11 percent of Vermonters earned • Housing & the Built Environment Rural areas of the state, where people may During the novel influenza H1N1 pandemic in incomes below the Federal Poverty Level A variety of health effects result when people live more than a short drive away from a well- State Assets 2009/10, basic health information was needed (see page 6 for a description of FPL). Low must live in sub-standard housing, or have no stocked grocery store, can seem to be a food in 11 languages plus English to communicate income Vermonters are more likely to be place to call home. desert – a place lacking in fresh, affordable and H Health Department District Offices Vermont benefits from a number of assets that with all Vermonters. These included: Arabic, female, young (age 18 to 34), less educated, nutritous foods. One expanding resource for are key to the Vermont Department of Health’s Burmese, Chinese, French, Nepali, Russian, unemployed or unable to work, or a member The “built environment” matters to health, local food products are farmers’ markets, held mission to protect and promote the best of Serbo-Croatian, Somali, Spanish, Swahili and of a racial or ethnic minority. too. Conditions, resources and policies in our throughout the growing season, and many HNewport health for all Vermonters. These assets will aid in indoor winter markets as well. implementing and monitoring the progress of Vietnamese. communities directly affect our exercise and HSt. Albans • Education play patterns, the kinds of foods, goods and our State Health Improvement Plan and Healthy According to the Vermont Center for Deaf and Education is closely linked with occupation and services that are available, the quality of the air • Access to Care Vermonters 2020 goals. Morrisville Hard of Hearing, more than 20,000 Vermonters income. Assessed together, these can provide we breathe and the water we drink, and how Approximately 90 percent of all Vermonters have H are living with hearing loss, 2,000 of whom are another measure of socioeconomic status. well we are able to connect socially with other some type of health insurance coverage. Only • The Vermont Department of Health is the profoundly deaf. Those who use American Sign people. 4 percent of children are uninsured. In 2011, HBurlington St. JohnsburyH single public health agency that serves all Language may require a professional interpreter Vermonters tend to have more years of formal nearly 14 percent of Vermonters were enrolled in Vermonters, with its central offices and lab in in many situations. Without access to health education than people in the rest of the U.S. Lead poisoning is a particular issue for children. Medicare, and nearly 20 percent were enrolled in Burlington, and 12 district offices located care or access to health information delivered In 2010, 90 percent of adults age 25 and In Vermont, as much as 70 percent of housing Medicaid. BarreH around the state. in plain English or their own native language, older had a high school education or more, was built before 1978, the year that lead was H many Vermonters do not have full access to compared to 85 percent for the U.S., and banned in residential paint. Children are also • Stress, Disability & Depression • Vermont is a small state, with a history of quality health care. 33 percent had earned a bachelor’s degree or exposed to lead by handling everyday objects, Stress as a risk to health is difficult to quantify. Middlebury collaboration among state government, more, compared to 28 percent for the U.S. such as keys, jewelry or even inexpensive toys. As a rough measure, in 2008, 21 percent of community agencies, coalitions, hospitals, • Income adult Vermonters reported that their day-to-day health centers and health care providers. Income is the most common measure of socio- Educational attainment varies across the state. Vermont has little traffic congestion or industry activities were limited due to physical, mental White River Jct.H economic status, and a strong predictor of the Adults in Chittenden and Washington counties that contributes to poor air quality. Even so, or emotional problems, and 6 percent reported H • State health reform efforts have included a health of an individual or community. have higher levels of educational attainment, there are days when high levels of fine having a health problem that required the use of Rutland focus on promoting health and preventing while those in the Canadian border counties particulate matter in the air make it risky for special equipment. chronic illness. Public Health is written into The lower the income, the less likely it is that a have lower levels. the very young, the very old, and people with the state’s health reform law. person will have a healthy diet or have regular chronic conditions such as asthma, to be out- Prevalence of disability increases among adults SpringfieldH physical activity, and the more likely he or she • Occupation doors and physically active. who have low income or less education. Adults • Dedicated public health professionals have will smoke. This leads to a greater likelihood of The state’s workforce numbers just over who have a disability are also more likely to expertise in evidence-based strategies for chronic conditions such as depression, obesity, 348,000, according to the U.S. Bureau of Labor Public transportation is limited in many areas have behaviors that compromise health – such achieving Healthy Vermonters 2020 and State asthma, diabetes, heart disease, stroke, and Statistics. The state unemployment rate in June of the state, making it difficult for many to get as smoking or physical inactivity – and to have BrattleboroH Health Improvement Plan goals. premature death. 2012 of 4.7 percent was lower than the national to work, school, play or exercise, health care, worse health outcomes. Depression among HBennington average of 8.2 percent. Unemployment affects groceries and markets, or community events. Vermonters correlates with lower income, less • The Health Department has a strong frame- In Vermont in 2011, the average per capita health, and this is documented by a variety of In recent years, a number of towns have worked education and under- or unemployment. work for performance management, and income was $28,376 and the median household data. People who report having high blood to create public transportation links, and to experience setting, monitoring and reporting income was $53,422, approximately the national pressure, depression, and who smoke are more construct sidewalks and paths for walking and – The Health Disparities of Vermonters 2010 on long term goals for the past 20 years, average. likely to be unemployed or unable to work. biking. starting with Healthy Vermonters 2000.

4 5 Vermont data are not comparable, or that the • Federal Poverty Level Reader’s Guide data are not available. A number of goals are yet In Vermont, disparities in health outcomes are Data Sources & References to be developed. often a function of income (or poverty) levels. Agency of Natural Resources For this reason, key data in this report have been • Department of Environmental Conservation data • Healthy Vermonters 2020 Goals charted by income level comparisons. Vermont • Behavioral Risk Factor Survey Changes Agency of Transportation This report presents more than 100 public Much of the data presented here comes from Agency of Education • Governor’s Highway Safety Program data health indicators and goals for 2020 in 21 focus the Behavioral Risk Factor Surveillance System Federal Poverty Guidelines are issued each year • School Health Profile Report Department of Financial Regulation areas organized into five thematic chapters: (BRFSS), a state-based system of health surveys by the U.S. Department of Health and Human • Insurance Survey A Healthy Lifetime established by the Centers for Disease Control Services. They are a national measure of poverty Agency of Human Services • • Vermont Uniform Hospital Discharge Data Set & Prevention (CDC) in 1984. BRFSS surveys a that takes income and household size into Department of Health • Providing for Better Public Health Department of Taxes sample of adults about their health conditions, consideration, and are used to determine • Adult Tobacco Survey • Behaviors, Environment & Health • Cigarette Excise Tax Stamp data risks and behaviors, practices for preventing eligibility for an array of programs and services. • Adult Blood Lead Epidemiology & Surveillance • Diseases & Health Conditions disease, and access to health care. • Asthma Call Back Survey Vermont Association of Hospitals & Health Systems • Public Health Preparedness These guidelines are sometimes referred to as • Behavioral Risk Factor Surveillance System Vermont Crime Information Center The steady rise in U.S. households that have only the Federal Poverty Level (FPL), as they are in • Blood Lead Surveillance System • Cancer Registry These goals were carefully identified by state cell phones has caused the BRFSS to add cell this report. United States government, health, health care and human phones to their samples. An estimated three of • Childhood Hearing Health data Agency for Healthcare Research & Quality services professionals, and the public as the 10 Americans and two in 10 Vermonters have In 2010, the FPL was income of $10,830 a year • Children with Special Health Needs data • Health Care Cost & Utilization Project priorities for improving the health of Vermont- only cell phones. for an individual, and $17,570 for a family of four. • Envision Program National Cancer Institute ers in this decade. The goals are calculated to • Food & Lodging Inspection data • Surveillance, Epidemiology & End Results Registries (SEER) be at least a 10 percent improvement by 2020. Adding cell phones to the survey samples was By 2012, the FPL increased to $11,170 a year for • Immunization Registry National Highway Traffic Safety Administration Each focus area presents information in charts, necessary to accurately reflect the population. an individual and $23,050 for a family of four. • Oral Health Survey US Census Bureau & US Bureau of Labor Statistics graphs and text to show where we are at the Cell phone users tend to be younger, single, and • Pregnancy Risk Assessment Monitoring System • Annual Social & Economic Supplement to the Current Population Survey beginning of this decade, and where we aim to rent instead of own their own homes, and there • Health Disparities by Race and Ethnicity • Radon Mitigation Survey US Department of Labor/Occupational Safety & Health Administration be by 2020. are differences in attitude and behaviors, too. Nationally, health disparities by race can be • Reportable Disease Surveillance data • Annual Survey of Occupational Injuries and Illnesses The addition of cell phones necessitated a new observed in, for example, cancer rates, injuries • School Nurse Report • Vermont/U.S. Comparisons system of weighting. or deaths from any cause. Statistically significant • Special Supplemental Nutrition Program for Women, Department of Health & Human Services State and national data as close to the baseline differences in health behaviors or outcomes Infants & Children (WIC) Centers for Disease Control & Prevention of 2010 are provided, and compared to each Starting with the 2011 BRFSS data, the result of between white non-Hispanics and people of • Vermont Dentist Survey • Healthy People 2020 Healthy Vermonters 2020 goal. When there is this change is reflected in increases or decreases racial and ethnic minority groups in Vermont are • Vermont Physician Survey • National Health & Nutritional Examination Survey a statistically significant difference between in certain statistics. noted in text throughout this report. • Vital Statistics System • National Healthcare Safety Network Vermont and U.S. data, it is noted with these • Youth Health Survey • National Immunization Survey symbols: For example, the adult smoking prevalence in • Youth Risk Behavior Survey • National Notifiable Disease Surveillance System Vermont for 2011 is reported as 20 percent, Department of Mental Health data • U.S. Renal Data System Vermont is statistically better than the U.S. J compared to 16 percent in 2010. Department of Vermont Health Access data Substance Abuse & Mental Health Services Administration Vermont is statistically worse than the U.S. 8 • National Survey on Drug Use and Health In some cases, we have noted that the U.S. and

6 7 INDICATORS/GOALS Intended Pregnancy Sexual Activity Preconception Health Counseling • Planning is Good for Family Health J statistically better than US 8 statistically worse than US % of pregnancies that women report are planned Among 9th-12th graders • 2011 % of women who talked with a health care worker about healthy Family planning is one of the 10 great public pregnancy before conception, by age • 2008 health achievements of the 20th century, help- Increase % of pregnancies that are planned Sexually active within ing men and women to be more intentional 100% the last 3 months about timing of pregnancy, birth spacing and 2020 Goal 65% 90% 13 % 6 % Not sexually active within family size. Family planning contributes to VT 2008 54% 80% the last 3 months healthier outcomes for everyone – babies, US data not comparable 70% 42% children, women, families and communities. Goal: 65% Increase % of youth who used contraception 60% 54% never had at most recent sexual intercourse * 50% sex: 81 % 32% • Intended vs. Unplanned Pregnancy Women who prepare for childbearing are more 2020 Goal 95% 40% • 9th-12th graders VT 2011 86%J likely to have good health habits before they US 2011 71% 30% Grade 9 become pregnant – to eat nutritious foods, 20% 16% take folic acid, be physically active, not smoke 10% and not drink, get into prenatal care early – and Increase % of youth who receive education 25 % their babies are more likely to be born healthy. on sexually transmitted diseases 2001 2002 2003 2004 2005 2006 2007 2008 Unplanned pregnancies can be costly, both in 9 % Teen Age 20–34 35+ health and social terms. This is especially true never had sex: 66 % for younger parents, who may be less educated,

Family Planning • females 2020 Goal * * * VT data not available Intended Pregnancy & Age of Mother Teen Pregnancy have lower incomes and greater dependence on US 2006-08 93% % of pregnancies that women report are intended • 2009 # of pregnancies per 1,000 females age 15-17 welfare, have more physical and mental stresses, Grade 10 and a worse outlook for the future. • males 2020 Goal * * * Intended Pregnancies VT data not available Unplanned Pregnancies • The Power of Reproductive Health Ed US 2006-08 92% 39 % 25 Reproductive health education in schools can never had empower teens to make informed decisions sex: 51 % 13% 20 about abstinence, sexual activity, contracep- 11 % tion and protection. Teens who have complete information and who are aware of their choices 30% 15 Grade 11 are better equipped to avoid pregnancy and 62% 69% 10 sexually transmitted diseases, and have a better 10.4 basis for healthy lifestyles and relationships as they enter adulthood. Younger than 20 Age 20–24 25–34 35+ never had 5 sex: 39 % 50 % In Vermont, white teens have a higher rate of 12 % 2001 2003 2005 2007 2009 pregnancy (13.6 per 1,000) than teens of racial or ethnic minority groups (8.7 per 1,000). Grade 12

* represents % of males and females who used contraception to avoid pregnancy * * * goal to be developed 8 Healthy Vermonters 2020 • A Healthy Lifetime 9 INDICATORS/GOALS Healthy Behaviors During Pregnancy Preconception Health Care • Sudden Unexpected Infant Death J statistically better than US 8 statistically worse than US % of pregnant women who – % of women who talked with a health care worker about having by age of woman • 2008 Recent public health and forensic research a healthy pregnancy before conception has shown that what had been called SIDS Reduce sudden, unexpected infant deaths 100 (Sudden Infant Death Syndrome) can be (# per 1,000 live births) Do Not Drink (Goal: 100%) 90 attributed to causes such as sudden infection, 2020 Goal 0.62 88% 50% maltreatment, unsafe sleep environment or rare 81% VT 2005-09 0.69 80 45% diseases. Keeping health care providers and US 2006 0.93 70 40% Goal: 40% Do Not Smoke (Goal: 90%) 42% families accurately informed about infant care 60 Increase % of pregnant women who – 35% and safety can help prevent sudden unexpected 50 30% deaths. 32% • drink no alcohol 2020 Goal 100% 40 25% 29% VT 2008 88% 30 20% • No Smoking, Alcohol, Drugs US data not comparable Smoking is the most preventable cause of low 20 15% 16% birth weight in babies, and low birth weight is • do not smoke 2020 Goal 90% 10 10% closely linked to infant mortality. A mother’s use VT 2009 81% 8 5% 2001 2002 2003 2004 2005 2006 2007 2008 2009 of even small amounts of alcohol or drugs can US 2007 90% cause developmental, neurological and physical 2004 2005 2006 2007 2008 Teen 20–34 35+ health problems for her baby. • do not use illicit drugs 2020 Goal 100% VT 2009 95% Infant Mortality Breastfeeding US data not comparable # of deaths within the first 12 months of life, per 1,000 live births % of women who breastfed their babies at any point during the first year of life by age of baby • 2007 • Importance of Preconception Care Preconception care promotes the health of Increase % of women delivering a live birth who – women of reproductive age by promoting Vermont health behaviors, screening and interventions to • discussed preconception health 100% 86% U.S. reduce risk factors and control conditions (such before pregnancy 2020 Goal 40% 90% 75% as high blood pressure, diabetes or asthma) that VT 2008 29% 8 78% might negatively affect a future pregnancy. US data not available 80% 7 58% 6.1 deaths per 1,000 live births 70% • Breastfeeding is Best Maternal & Infant Health • had a healthy weight 6 60% 43% 40% Scientific evidence is clear that breastfeeding for before pregnancy 2020 Goal 65% 5 50% VT 2008 52% the first six months of life helps prevent obesity US data not comparable 4 40% 22% and Type 2 diabetes. Breastfeeding mothers are 3 30% also at lower risk of breast and ovarian cancer, Increase % of infants who are breastfed exclusively 2 20% diabetes, hypertension and cardiovascular through 6 months 1 10% disease. Among WIC participants in Vermont, 2020 Goal 40% At birth At 6 months At 1 year 82% of mothers of racial or ethnic minority VT 2007 22% J 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2000 2002 2004 2006 2008 2010 groups breastfeed their babies, compared to US 2007 14% 77% of white non-Hispanic mothers.

10 Healthy Vermonters 2020 • A Healthy Lifetime 11 Older Adults INDICATORS/GOALS • Newborn Screening for Hearing • Welcome to Medicare INDICATORS/GOALS J statistically better than US 8 statistically worse than US At least one in six Americans has a sensory or Medicare covers all the costs for a one-time, J statistically better than US 8 statistically worse than US communication impairment or disorder. Even comprehensive “Welcome to Medicare” Increase % of babies – when temporary and mild, such disorders can preventive visit during the first 12 months of • who are screened for hearing loss 2020 Goal 100% Increase % of older adults who use J affect health. Any barrier to physical balance and having ‘Part B.’ After 12 months, a yearly wellness by 1 month of age VT 2009 95% communication with others can make a person visit to develop or update a personalized plan the Welcome to Medicare benefit US 2007 82% feel socially isolated, have unmet health needs, to prevent disease based on current health and 2020 Goal 25% VT data not available and limited success in school or on the job. Very risk factors is covered. Anyone with Medicare • who need and receive 2020 Goal 55% US 2008 7% an audiological evaluation VT 2009 48% 8 early screening and intervention for hearing is eligible for this benefit, and there is no cost if by 3 months of age US 2007 66% loss improves physical development, language, the doctor or other health care provider accepts learning and literacy for these children. Five Domains Welcome to Medicare assignment. This is a valuable health benefit, yet Increase % of older adults who are up to date • with hearing loss who receive 2020 Goal 55% of Healthy Wellness Exam few people take advantage of it. on recommended preventive services intervention services VT 2009 50% • Well Child Ready for School Development: by 6 months of age US 2007 50% Social and emotional development in early • The Wellness Visit • females 2020 Goal 55% childhood is strongly connected with later Covers: During the visit, the health care provider will VT 2010 47% Increase % of children – academic achievement. Early and continuous • Social-Emotional • Medical/Family History complete a comprehensive physical exam, US 2008 48% • who are screened for Autism Spectrum Disorder developmental screening results in timely Development evaluate the patient’s medical history, and: and other developmental delays VT/2020 Goal * * * • Health Conditions identification and referral. This is important so • males 2020 Goal 55% by 24 months of age US 2007 20% • Approaches to Learning • Prescriptions VT 2010 50% that children arrive at Kindergarten competent • Communication • record and evaluate medical and family history, US 2008 46% • with Autism Spectrum Disorder diagnosis in all five developmental domains. • Blood Pressure current health conditions, and prescriptions who have first evaluation VT/2020 Goal * * * • Cognitive Development • Vision by 36 months of age US 2006 39% • Wellness Check-ups for Adolescents • Wellness • Weight/Height • check blood pressure, vision, weight and High quality preventive services for school-age height to get a baseline for care • who are ready for school 2020 Goal 65% youth include annual well exams, with assess- Well children demonstrate • Vaccinations in five domains VT 2010 56% ments of physical activity, nutrition, sexual age-appropriate self-help • Preventive Health • make sure clinical preventive services such of healthy development US data not available behavior, substance abuse and behaviors that skills, and seldom or never Screenings as cancer screenings and vaccinations are can result in injuries. up to date • age 10-17 who have 2020 Goal 65% appear to be inhibited by had a wellness exam VT 2010-11 57% illness, fatigue or hunger. in the past 12 months US data not comparable • Quality Early Health Education • order further tests, depending on patient’s

Early Childhood Screening Health education by qualified teachers builds Vermont’s Statewide Report general health and medical history Decrease % of students absent VT/2020 Goal * * * the knowledge, attitudes and skills that students on Kindergarten Readiness from school due to illness/injury US 2008 5% need to make healthy decisions, become health 2011-2012 • The Wellness Plan literate, and look out for the health of others. Following the visit, the health care provider will Increase % of middle schools VT/2020 Goal * * * Curricula should address tobacco/alcohol/drug provide a plan or checklist with free screenings that require newly hired staff US 2006 51% use, nutrition, mental and emotional health, and preventive services needed. who teach Health Education physical activity, safety and injury prevention, to be State licensed or endorsed sexual health and violence prevention.

* * * Vermont data not available and goal to be developed 12 Healthy Vermonters 2020 • A Healthy Lifetime 13 INDICATORS/GOALS Supply of Primary Care Physicians No Health Insurance • Health Insurance for All J statistically better than US 8 statistically worse than US # Full-Time Equivalent (FTE) physicians per 100,000 people, by county • 2010 Having good health insurance is the starting Uninsured Vermont adults age 18+ U.S. adults age 18+ point for a person’s access to quality health care. Increase # of practicing primary care providers Includes Medical Doctors (MDs) and Doctors of Osteopathic Medicine (DOs) 20% Uninsured Vermont children under 18 years U.S. children <18 Compared to the U.S., Vermonters, especially # Full Time Equivalents (FTEs) - US data not available 18% children, have had higher rates of insurance coverage. The goal of universal health insurance • MDs and DOs 2020 Goal 541 15% coverage is well within reach. VT 2010 492 Grand Isle Orleans 7.5 Franklin Essex 67.3 11% • Importance of a Medical Home • Physician Assistants 2020 Goal 80 64.3 36.9 VT 2010 67 10% 10% Having good access to health care means more Lamoille than simply having insurance. A medical home • Nurse Practitioners 2020 Goal 100 74.3 is a consistent health care setting with a regular 5% VT 2010 83 Chittenden Caledonia primary care provider or team that ensures 96.2 71.2 # FTEs, by county 4% quality and appropriate care that includes Increase % of people who have Addison 29 Washington clinical preventive services such as vaccinations, health insurance 2020 Goal 100% Bennington 31 blood pressure and cholesterol checks, cancer 81.5 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Caledonia 22 screenings, etc. • adults age 18+ VT 2010 89% J Chittenden 151 US 2010 82% Addison 79.0 Orange Essex 2 Access to Routine Health Care Health Insurance & Income • Unequal Access to Quality Care • younger than 18 VT 2010 96% J 60.6 Franklin 31 % of people following recommended preventive health % of adults age 18-64 who have health insurance, Health insurance coverage is not equal across US 2010 90% Grand Isle .5 measures • 2010 by Federal Poverty Level • 2010 all groups in the state: eight out of 10 adults Lamoille 18 n among those who have a primary care physician of racial or ethnic minority groups have health • all ages VT 2010 91% J n among those who don’t lower income greater income insurance coverage and a primary care provider, Rutland Windsor Orange 18 US 2010 84% 75.4 Orleans 18 compared to nine of 10 white non-Hispanics. 61.7 Rutland 38 73% 72% 95% 97% Insurance coverage is nearly universal among Increase % of adults who have a 69% people with the highest incomes, while two of Washington 49 86% usual primary care provider 2020 Goal 100% KEY: 81% 10 adults at the lowest income levels have no VT 2010 90% J Windham 42 53% health insurance. Access to Health Services US 2010 82% Adequate Supply Windsor 43 Bennington > 78 per 100,000 Physicians Accepting New Patients 83.9 37% Reduce % of people who cannot obtain care, Windham Limited Need % of primary care physicians who accepted — or delay medical or dental care 68 - 78 per 100,000 28% 94.7 or prescriptions 2020 Goal 5% Severe Need 2000 2006 2010 VT 2010 9% J < 68 per 100,000 US 2010 15% any new patients 80% 82% 83% new Medicaid patients 72% 68% 72% Increase % of people who have a specific Statewide: 78.6 FTEs per 100,000 people Screened for Had flu shot in Had regular checkup < 1¼ times 1¼ - 2½ times 2½ - 3½ times > 3½ times source of ongoing health care * * * colorectal cancer past year in past year poverty level poverty level poverty level poverty level Age 50+ Age 65+ Age 18+ new Medicare patients 73% 72% 69% Increase % of people with insurance coverage for clinical preventive services * * * * * * comparable Vermont /U.S. data not available and goal to be developed 14 Healthy Vermonters 2020 • Providing for Better Public Health 15 INDICATORS/GOALS Immunization Status for Kindergarteners Immunization Status for Babies • Why Vaccinate? J statistically better than US 8 statistically worse than US % of children entering Kindergarten, by immunization status % of babies age 19 to 35 months who have had recommended vaccinations * A person who is fully immunized is protected Vermont against vaccine-preventable diseases or severe Increase % of children age 19-35 months Religious or illness, and helps protect the community from 1,2,3 philosophical U.S. who receive recommended vaccines * 100% 100% disease outbreaks. Children, adolescents and 6% exemption 1 2020 Goal 80% 90% Vaccine Series Goal: 90% adults should be vaccinated according to the VT 2010 41% 90% 11% Provisional 80% admittance 80% 81% Centers for Disease Control & Prevention (CDC) US 2010 57% recommendations. 70% 83% Fully vaccinated 70% 65% Increase % of children in Kindergarten who are vaccinated 60% 60% with two or more doses of MMR vaccine • Vaccinate for Life 50% 50% 2 (measles, mumps, rubella) 2020 Goal 95% + Varicella vaccine 41% In Vermont in 2010, 6% of children entering VT 2010-11 91% 40% Kindergarten had a religious or philosophical US data not comparable 30% exemption, one of the highest percentages of 20% all the states. Another 11% entered provisionally, 3 Increase % of youth age 13-15 who are vaccinated 10% + Pneumococcal vaccine without being up to date on their vaccinations. with one dose of Tdap vaccine Because immunity to some diseases wanes over (tetaunus, diphtheria, pertussis) 2020 Goal 90% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 time, adolescents need one dose of the Tdap VT 2010 83% vaccine between age 13 and 15 to boost their US data not comparable Increase % of adults age 65+ who – Adult Influenza/Pneumonia Immunization Vaccine Series for Babies immunity. Routine annual flu vaccination is now • receive an annual flu shot 2020 Goal 90% % of people age 65+ who are vaccinated % of babies age 19-35 months who are fully immunized with five universally recommended vaccines • 2010* recommended for everyone age 6 months and VT 2010 71% J older. Pneumococcal vaccine is recommended n US 2008 66% Vermont for everyone age 65 and older, and for those 1 n U.S. 100% Vaccine Series with high-risk conditions. • have ever been vaccinated 2020 Goal 90% 90% Goal: 90% DTaP to prevent Diphtheria, Tetanus and Pertussis 86% against pneumonia VT 2010 73% J (Whooping Cough) 4+ doses DTap • Treat Tuberculosis 80% Pneumonia Vaccine (ever) 73% 84% US 2008 68% Polio to prevent Polio Vermont averages five cases of TB every year. 70% Active (infectious) TB can be treated with a nine Increase % of treatment completion among contacts MMR to prevent Measles, Mumps and Rubella 94% 60% Hib to prevent Haemophilus Influenzae b 3+ doses Polio month course of antibiotics, but this treatment to sputum smear positive cases who are diagnosed Influenza Vaccine (in past year) 71% 93% with latent TB and started treatment 50% Hep B to prevent Hepatitis B must be completed to be effective. 2020 Goal 90% 40% 1+ dose MMR 93% VT 2006-10 88% 30% + Varicella Vaccine 2 92% • Reduce Health Care Associated Infections US 2007 68% 20% to prevent Varicella (Chickenpox) A central line-associated bloodstream infection 52% is serious. Infection happens when germs enter 10% 4 doses Hib Reduce rate of central line-associated + Pneumococcal Vaccine 3 67% the bloodstream through a central line (tube) bloodstream infections 2020 Goal 0.15 that health care providers place in the patient’s 2000 2002 2004 2006 2008 2010 to prevent Pneumococcal Disease 92% VT 2010 0.78 3+ doses Hep B body to give fluids, blood or medications or to US 2010 0.68 92% do certain medical tests quickly. Immunization & Infectious Disease & Infectious Immunization

* A national shortage of Hib vaccine contributed to lower rates of fully immunized babies in Vermont and the U.S. for 2009 and 2010. 16 Healthy Vermonters 2020 • Providing for Better Public Health 17 INDICATORS/GOALS How Vermonters Pay For Dental Care Sealants in Children Tooth Decay in Children • Important to Overall Health J statistically better than US 8 statistically worse than US % by method of payment • 2009 % of 3rd graders who have sealants, Vermont % of 3rd graders who have untreated dental decay, Vermont Good oral health is integral to overall health. compared to other states with oral health surveys • 2009-2010 compared to other states with oral health surveys • 2009-2010 Tooth decay is one of the most common Increase % of population served by community public water chronic diseases in children, and gum disease systems that have optimally fluoridated water with insurance out of pocket affects a high percentage of adults. Infection 64% 63 % and inflammation in the mouth have been 2020 Goal 65% Medicaid linked to complications of pregnancy, Type 2 8 10 % VT 2010 57% 60% 60% diabetes, heart disease and stroke. US 2008 72%

Increase % of people who use the dental care system 46% • Fluoridation is a Public Health Benefit each year Private Insurance 37% Fluoridation has a proven track record of more 17 % than 50 years for preventing dental decay, and it • age 6-9 2020 Goal 100% 15% 24% benefits everyone in the community, regardless Oral Health 21% VT 2010 95% 17% of socioeconomic status. Yet fewer than 60% of US data not available 12% Vermonters served by community public water Self-Insured systems have optimally fluoridated water. • grades K-12 2020 Goal 85% 10 % Vermont NH ND MA CO Vermont CO ND MA NH VT 2009-10 65% • Oral Health Care for All US data not available Access & Income Tooth Extractions & Income Tooth Extractions & Age Vermont has one of the highest rates of oral • age 18+ 2020 Goal 85% % of adults who used the dental care system in the last year, by Federal Poverty Level • 2010 % of adults age 45 to 64 who have ever had any teeth extracted, % of adults who have ever had any teeth extracted, by age • 2010 health care use and dentist participation in VT 2010 74% J by Federal Poverty Level • 2010 Medicaid in the nation. But not everyone has access to quality care. Delays in treatment can US 2010 68% lower income greater income cause pain, infection and complications for lower income greater income Reduce % of children who have ever had decay Goal: 85% other health conditions. Improving the overall 77% health of all Vermonters will depend in part on 83% 85% • age 6-9 2020 Goal 30% making sure that everyone who has health care VT 2010 34% has oral health care, too. US data not comparable 66% 58% 52% 54% 51% Goal: 45% • Preventing Dental Decay Reduce % of adults age 45-65 who have ever 42% Efforts to reduce childhood caries include school fluoride mouthrinse programs, finding had a tooth extracted 33% 2020 Goal 45% a dental home for children who have not been VT 2010 52% 24% to the dentist, and adding oral health to WIC US 2010 54% services for some participants. Improvements in preventive efforts and clinical treatment have made it possible for more people to keep all of < 1¼ times 1¼ - 2½ times 2½ - 3½ times > 3½ times < 1¼ times 1¼ - 2½ times 2½ - 3½ times > 3½ times Age 18–44 45–64 65+ poverty level poverty level poverty level poverty level poverty level poverty level poverty level poverty level their teeth for most of their lives.

18 Healthy Vermonters 2020 • Providing for Better Public Health 19 INDICATORS/GOALS Suicide Deaths Youth Suicide Attempts Adult Depression & Income • What is Mental Health? J statistically better than US 8 statistically worse than US # of deaths per 100,000 Vermonters % of 9th-12th graders who reported making a suicide attempt, % of adults who report depression, by Federal Poverty Level • Mental health is a state of successful mental whether or not it required medical attention 2010 function and performance that results in Reduce suicide deaths lower income greater income productive activities, fulfilling relationships with (# per 100,000 people) 15 15% other people, and the ability to adapt to change 2020 Goal 11.7 and to cope with challenges. Mental health VT 2009 13.0 13.0 20% is essential to personal well-being, family and US 2007 11.3 Goal: 11.7 interpersonal relationships, and the ability to 10 Decrease % of suicide attempts 10% contribute to community or society. that require medical attention 2020 Goal 1.0% Mental disorders are health conditions that are • youth grades 9-12 VT 2009 1.6% 5 characterized by alterations in thinking, mood US 2009 1.9% 5% 4% 9% or behavior associated with distress or impaired functioning. Mental disorders contribute to a Increase % of people who have primary care 5% host of problems, including disability, pain or provider visits that include depression screening death. Mental Health 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 3% 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 VT/2020 Goal * * * < 1¼ times 1¼ - 2½ times 2½ - 3½ times > 3½ times Mental illness is the term that refers collectively to • adults US 2007 2.2% poverty level poverty level poverty level poverty level • youth age 12-18 US 2005-07 2.1% Depression & Chronic Illness all diagnosable mental disorders. Symptoms of In 2010, % of adults who report having depression, among those who have — mental illness often lessen over time, and people Youth Depression & Age/Gender Adult Depression & Age/Gender can enjoy considerable improvement or full % of 9th-12th graders who report feeling sad or helpless • 2011 % of adults who report depression • 2010 recovery.

Asthma 17% n male n female n men n women • Depression is a Chronic Illness Depression is a chronic illness that is associated Diabetes 16% with other chronic conditions. In Vermont, adults Lung Disease 15% 26% 26% of racial and ethnic minority groups are more (COPD) 23% 23% likely to report moderate to severe depression Obesity 14% (17%) compared to white non-Hispanic adults (7%). Young people of racial and ethnic minority 17% Heart Disease / 11% groups are more likely to make a suicide attempt Stroke 14% 10% 13% 13% 9% that requires medical attention (5%) compared 12% 8% Cancer 11% to white non-Hispanic youth (1%). However, 6% 6% 5% white non-Hispanic adults have a higher rate Currently Smoke 19% 3% of death from suicide (14.1 per 100,000 people) compared to adults of racial and ethnic minority 7% of all adults report depression Grade 9 Grade 10 Grade 11 Grade 12 Age 18–24 Age 25–44 Age 45–64 Age 65+ groups (4.5 per 100,000).

* * * Vermont data not available and goal to be developed 20 Healthy Vermonters 2020 • Providing for Better Public Health 21 INDICATORS/GOALS Youth Alcohol / Other Drug Use Marijuana Use Marijuana Use • Health Consequences of Alcohol J statistically better than US 8 statistically worse than US % of 9th–12th graders who have ever used drugs or alcohol • 2011 % of people who report using marijuana in the past 30 days • % of youth in grades 9-12 who report using marijuana Alcohol plays a major role in many motor 2009-10 in the past 30 days vehicle crash fatalities, suicides, domestic Decrease % of youth who binge drink * violence and unintentional injuries. Fetal 3% 3% exposure to alcohol (and drugs) causes 2020 Goal 10% 40% developmental, neurological and physical • youth age 12-17 VT 2008-09 11% 35% health problems. A baby born with Fetal Alcohol US 2008-09 9% 30% Effects faces a lifetime of serious and irreversible 24% problems. Recent scientific evidence suggests Decrease % of youth who used marijuana Heroin Methamphetamines 25% 24% 20% that using marijuana may harm thinking, in the past 30 days 20% Goal: 20% judgment, physical and mental health. 15% 2020 Goal 20% • youth grades 9-12 VT 2011 24% 8% 10% 6% 10% • Binge Drinking & Marijuana Use US 2011 23% 5% The age when a young person starts drinking strongly predicts alcohol dependence. Reduce % of people who need and do not receive 9-12th 18-25 26 and 1999 2001 2003 2005 2007 2009 2011 Easy access and perception of risk matter, too. graders years old older treatment for alcohol use In 2011, 9% of 6th-8th graders reported drink- Inhalants Hallucinogens ing before age 11, 4% reported binge drinking 2020 Goal 5% in the past month, and 40% said that alcohol is • youth age 12+ VT 2008-09 7% Binge Drinking US 2008-09 7% % of people who report binge drinking in the past 30 days 12–17 years old easy to get. Alcohol and illicit drug use often go 18–25 years old hand in hand: 39% of Vermont 9th-12th graders 14% 26 and older reported ever using marijuana, and 62% said that marijuana is easy to get. Of all the states, 24% 55% 52% Vermont has one of the highest rates for 50% marijuana use among young people. Prescription Drugs Cigarettes 45% 40% US • More Treatment Services Needed

41% Unmet addiction treatment need is defined as 35% an individual who meets the criteria for abuse 30% Alcohol & Other Drug Use Alcohol & Other Drug of, or dependence on, illicit drugs or alcohol, but 24% 25% has not received specialty addiction treatment

20% 22% in the past year. 39% 15% 11% 60% 10% In Vermont, adults of racial and ethnic minority Marijuana Alcohol 9% 5% groups are more likely to use marijuana (13%), compared to white non-Hispanics (8%). 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09

* 5 or more drinks on a single occasion, once or more often in the past 30 days 22 Healthy Vermonters 2020 • Behaviors, Environment & Health 23 INDICATORS/GOALS Cigarette Smoking Tobacco Policies Timeline • Tobacco: Still the #1 Real Killer J statistically better than US 8 statistically worse than US % of Vermonters who are current smokers, by age group In 1993, Vermont had the first Clean Indoor Air Act in the U.S. Tobacco is still the leading cause of preventable 2002 Single cigarette sales banned death. Smoking leads to or complicates asthma, Reduce % of adults who smoke cigarettes 1987 Smoke-free workplace law Cigarette tax increased to $1.19 heart disease, cancer, lung diseases, stroke, low 45% 1991 Sales to <18 years old banned 2005 Comprehensive Clean Indoor Air Act birth weight in babies, and infant mortality. 2020 Goal 12% 40% 1993 Clean Indoor Air Act Smoke-free foster homes/cars Of the estimated 75,500 adult Vermonters who VT 2010 16% smoked in 2010, half of those who continue will 35% age 18-24 2006 Cigarette tax increased to $1.99 US 2010 17% 1995 Smoke-free schools likely die of a smoking-related cause. 30% Vermont Kids Against Tobacco (VKATs) started 2007 Youth Access Quit Line started Reduce % of youth who smoke cigarettes Grades 9-12 (Goal: 10%) 25% 1997 Vending machine sales banned 2008 Internet/mail order sales banned • Who Smokes and Who Does Not? 20% About one-third of very low income (31%), and • 9th-12th graders 2020 Goal 10% 16% 2001 Quit Line begins 2009 100% smoke-free workplaces all adults (Goal: 12%) uninsured (35%) adults smoke. Those who did VT 2011 13% J 15% Our Voices Exposed (OVX) started Cigarette tax increased to $2.24 US 2011 18% 13% not graduate from high school are more likely 10% 2000 Vermont Tobacco Control Program begins 2010 Cigarette tax increased to $2.62 Tobacco Use Tobacco to smoke (39%), and an estimated 38% of adults Increase % of adult smokers who attempted to quit 5% with mental illness smoke. Also in Vermont, 27% smoking in the past year of adults and 19% of youth of racial and ethnic 2020 Goal 80% 1999 2001 2003 2005 2007 2009 2011 minorities are current smokers, compared to VT 2010 62% 17% of adults and 13% of white non-Hispanic US 2010 58% Smoking & Chronic Disease Smoking & Income Quit Attempts youth. Establish statewide laws on smoke-free indoor air Smoking status of adults who have chronic illnesses • 2010 % of current adult smokers, by Federal Poverty Level • 2010 % of current adult smokers who made an attempt to quit smoking that prohibit smoking in public places • Exposure to Smoke = Smoking Goal: 80% There is no safe level of exposure to second- ever smoked never smoked lower income greater income 2020 Goal 12 (of 17) hand smoke, yet 43% of adult nonsmokers in 70% VT 2010 8 Lung Disease 79% 62% Vermont report having been exposed recently. US data not available (COPD) 21% 60% Laws and bans on smoking in public places, at Heart Disease/ 64% 32% home and in the car, lead to quit attempts. 3 Vermont has smoke-free laws in place Stroke 36% 50%

≠ Vermont does not have smoke-free laws in place • Most Smokers Try to Quit Depression 61% 39% 40% Quitting has almost immediate health benefits, 3 Private Workplaces ≠ Entrances/Exits to Public Places 19% but it can take many tries before a smoker can Diabetes 58% 30% 3 Public Workplaces ≠ Mental Health Treatment Facilities 42% quit successfully. Every year since 2004, more 3 Restaurants ≠ Substance Abuse Treatment Facilities Arthritis 57% 11% 11% 20% than half of all smokers in Vermont have made a 3 Bars ≠ Multi-Unit Housing 43% quit attempt. At 69%, smokers of racial or ethnic 3 Public Transportation ≠ Hotels/Motels Hypertension 56% 10% minorities have a higher quit attempt rate than 3 44% Commercial Day Care Centers ≠ College Campuses < 1¼ times 1¼ - 2½ times 2½ - 3½ times > 3½ times white non-Hispanic smokers (58%). 3 Home-Based Day Care Centers ≠ Hospital Campuses poverty level poverty level poverty level poverty level 2002 2004 2006 2008 2010 54% of all adults have never smoked 3 Prisons/Correctional Facilities ≠ Vehicles with Children ≠ Gaming Halls

24 Healthy Vermonters 2020 • Behaviors, Environment & Health 25

INDICATORS/GOALS Prevalence of Overweight & Obesity in Adults Weight & Income Obesity & Chronic Disease • A Growing Trend toward Obesity J statistically better than US 8 statistically worse than US % of adults age 20+ % of obese adults age 20+, by Federal Poverty Level • 2010 In 2010, % of adults who report being obese, Vermonters, like other Americans, are growing 80% among those who have — more overweight – a trend that holds true for Reduce % of adults age 20+ who are obese lower income greater income both adults and children. Obesity is a complex, (as measured by BMI *) 70% multi-faceted condition but, simply stated, is the 2020 Goal 20% 33% result of eating too much and moving too little. VT 2010 25% J 60% Diabetes US 2010 28% 29% 50% 62% • After Smoking, Obesity is #2 Real Killer Overweight (BMI 25-29) 35% The terms ‘overweight’ and ‘obese’ describe Reduce % of children and youth who are obese 40% 20% Heart Disease / Stroke (as measured by age-specific BMI *) 19% weight ranges that are above what is medically 30% 44% considered to be healthy. Being overweight or • children age 2-5 * * • youth grades 9-12 obese greatly increases a person’s risk for many 20% 2020 Goal 10% 2020 Goal 8% 25% Hypertension serious health conditions, including high blood VT 2010 12% VT 2011 10% Obese (BMI 30+) 10% 44% pressure, high cholesterol, Type 2 diabetes, heart US data not comparable US 2011 13% disease and stroke, gallbladder disease, osteoar- < 1¼ times 1¼ - 2½ times 2½ - 3½ times > 3½ times thritis, sleep apnea and some cancers. 2000 2001 2002 2003 2004 2005 2006 2007 2008 209 2010 poverty level poverty level poverty level poverty level Asthma Reduce % of households with food insecurity 35% • Who is at Risk? Obesity affects people of all racial and ethnic 2020 Goal 5% Prevalence of Overweight & Obesity in Youth Arthritis VT 2006 8% % of youth in grades 9–12 backgrounds, income and education levels. US data not comparable Weight & Healthy Diet 30% In Vermont, the highest rates are among those Nutrition & Weight % of adults in each weight category who eat at least people who have lower incomes. Increase % of people who eat 2+ servings of fruit/day 80% five servings of fruit and vegetables each day • 2009 Depression 44% • The Problem with Food Insecurity • youth grades 9-12 • adults age 18+ 70% Food insecurity means not having enough food 2020 Goal 40% 2020 Goal 45% 35% 60% to eat and not having enough money to buy VT 2011 36% VT 2009 38% J Inadequate physical activity food. Adults who do not have food security US 2011 34% US 2009 32% 30% 50% (does not meet recommendations) must often compromise quality for quantity, 27% buying less nutritious and higher-calorie, but Increase % of people who eat 3+ servings of vegetables/day 40% 32% 22% lower-cost foods for themselves and their • youth grades 9-12 • adults age 18+ 30% families. 2020 Goal 20% 2020 Goal 35% J 20% Overweight (85th percentile) 25% of all adults VT 2011 17% VT 2009 30% 13% are obese • Eat More Colors! US 2011 15% US 2009 26% 10% A healthy diet includes five servings of fruit and Obese (95th percentile) 10% vegetables every day. Vermont youth of racial 1999 2001 2003 2005 2007 2009 2011 Underweight Healthy Overweight Obese or ethnic minority groups are more likely to eat Weight at least five servings (31%), compared to white non-Hispanic youth (24%). * To calculate Body Mass Index (BMI) for adults: go to healthvermont.gov, then select Fit & Healthy Vermonters. * * among children enrolled in WIC 26 Healthy Vermonters 2020 • Behaviors, Environment & Health 27 INDICATORS/GOALS Physical Activity Physical Activity & Income Chronic Disease & Physical Activity • Move More! J statistically better than US 8 statistically worse than US % of Vermonters who meet physical activity guidelines % of adults who meet physical activity guidelines In 2010, % of people who do not get the recommended amount of Physical activity is any body movement that by Federal Poverty Level • 2010 physical activity, among those who have— speeds up your heart beat and makes you 70% breathe harder. Regular physical activity is one Reduce % of adults who have no leisure time physical activity lower income greater income of the best things you can do for your health. Adults 60% 59% It helps build and maintain bones and muscles, • adults age 18+ 2020 Goal 15% Obesity control weight, improve your strength and VT 2010 17% J 50% endurance, and makes you feel better, both US 2010 24% 63% 63% 54% physically and mentally. 40% 53% 54% Youth – grades 9–12 Asthma • Physical Activity Guidelines Increase % of people who meet physical activity guidelines 30% 51% 24% Adults need an average of at least 150 minutes 20% • adults age 18+ 2020 Goal 65% Current Smoker each week of moderate intensity physical VT 2009 59% J activity such as brisk walking (30 minutes, five US 2009 49% 10% 46% < 1¼ times 1¼ - 2½ times 2½ - 3½ times > 3½ times days a week) – or at least 75 minutes of vigorous poverty level poverty level poverty level poverty level intensity exercise (15 minutes, five days a week). • youth grades 9-12 2020 Goal 30% Hypertension Adults should also try to do muscle-strengthen- VT 2011 24% 8 2001 2003 2005 2007 2009 2011 ing activities two or more days each week. US 2011 29% 44% Physical Activity Screen Time & Weight % of 9th-12 graders who spend at least 3 hours of leisure time Arthritis For children and teens, physical activity should add up to 60 minutes or more each day. Each Increase % of children age 2-5 who do not watch TV, videos Perception of Health in front of a TV or computer screen • 2011 44% or play video or computer games more than 2 hours/day Among all adults who meet physical activity guidelines • 2010 week should also include three days of some n 3–5 hours n 5 hours + vigorous-intensity activity like soccer, basketball, Diabetes 2020 Goal * * * running or swimming, and three days of muscle 41% and bone-strengthening activities such as gym- Increase % of youth in grades 9-12 who have no more Fair / Poor nastics or climbing on a jungle gym. In Vermont, than 2 hours of screen time per day * * * * Heart Disease / Stroke more white non-Hispanic youth meet physical

39% activity guidelines (48%), compared to youth of 2020 Goal 70% 34% racial or ethnic minority groups (42%). VT 2010 64% 60% US data not comparable Excellent / Very Good Healthy Weight Overweight Obese • Limit Screen Time! 41% of all adults fail Television viewing, video gaming and computer to meet recommendations use are the most common sedentary leisure for physical activity time activities in the U.S. Rates of screen time among children and adolescents are increasing, and this trend is associated with inactivity and a rise in obesity.

* * * Vermont/U.S. data not available and goal to be developed * * * * outside of school for non-school work 28 Healthy Vermonters 2020 • Behaviors, Environment & Health 29 INDICATORS/GOALS Unintentional Injury Deaths, by Cause Deaths from Falls Hospitalizations for Falls • Many Injuries are Preventable J statistically better than US 8 statistically worse than US # injuries each year per 100,000 people • 2005-2009 # of deaths per 100,000 people, all ages # of hospitalizations each year per 10,000 people, Injuries are a leading cause of disability and by age • 2005-2009 death for all Vermonters, regardless of a person’s Reduce non-fatal motor vehicle crash-related injuries age, gender or socioeconomic status. Whether (# hospital/emergency department visits per 10,000 people) 17.9 20 539.0 n men n women they are unintentional or the result of intention- 17.0 al or violent acts, most injuries can be prevented 2020 Goal 785.8 with public health interventions. White non- 375.2 VT 2008 873.1 11.8 15 Hispanic Vermonters are more likely to die of US data not comparable Injuries unintentional injuries (4.9 deaths per 100,000 people) than those of racial and ethnic minority Reduce fall-related deaths among people age 65+ 7.9 221.8 (# per 100,000 people) 10 groups (1.2 deaths per 100,000). 2020 Goal 116.9 137.7 VT 2009 129.9 8 • Motor Vehicle Crashes 1.8 75.0 US 2007 45.3 1.4 1.1 1.0 5 50.1 Motor vehicle injuries are a significant cause of 12.7 9.7 injury and death, both nationally and in Vermont. Reduce emergency department visits for self-harm injuries Falls Motor Vehicle Poisoning Suffocation Other Drowning Fire / Burn Age < 65 65–74 75–84 85 + This is especially true for teens and older people. (# visits per 10,000 people) Transport 2000 2002 2004 2006 2008 2010 The underlying causes are many and complex: 2020 Goal 139.1 young or inexperienced drivers, drinking under VT 2009 154.6 US 2008 125.3 Injury Hospitalizations ED Visits for Motor Vehicle Crashes Suicide Deaths the influence, speeding and distracted driving, # of hospitalizations each year per 10,000 people, by cause of injury • 2005-2009 # of visits to the Emergency Department each year per # of deaths each year per 100,000 people • 2005-2009 often in combination with snow and ice. 10,000 people • 2005-2009 41.2 • Falls 213.2 n n n n Unintentional falls are not accidents, but are n men n women male female male female 36.8 preventable with specific interventions. Fall 171.8 injuries for the elderly can have a profound 29.3 impact on quality of life, mobility, independent 26.6 26.9 living, and increased risk of early death.

104.4 7.8 96.6 • Self-harm or Suicide Attempts White non-Hispanic adults in Vermont have a 14.2 higher rate of suicide (14.1 per 100,000 people) 5.2 56.5 47.6 9.7 than people of racial and ethnic minority groups 39.4 36.5 7.8 2.9 2.5 2.7 2.6 27.6 27.6 (4.5 per 100,000). Main methods of suicide are 3.2 3.2 1.4 1.3 firearms, poisoning and suffocation. Mental ill- ness, life trauma, death of a family member and personal economic crisis are major risk factors. Falls Motor Vehicle Other Transport Struck Poisoning Age < 15 15–24 25–44 45–64 65 + Age < 35 35–54 55–74 75 + offroading, bikes, etc. Everyone can play a role in preventing suicidal or self-harm behaviors in others. * hospital and emergency department visits 30 Healthy Vermonters 2020 • Behaviors, Environment & Health 31 INDICATORS/GOALS Older Housing Stock Blood Lead Level Testing Safe Drinking Water • Lead J statistically better than US 8 statistically worse than US % of housing built before 1980 that may present lead hazard, by town • 2000 Census Block data % of children tested for lead poisoning % of people on public drinking water systems whose water There is no safe level of lead in the body. meets standards In children, exposure to lead may result in Increase % of the population served by community public learning disabilities, behavioral problems, water supplies that meet Safe Drinking Water standards 100% 100% decreased intelligence and poisoning. Goal: 95% 90% 90% Lead paint and dust from lead paint are the 2020 Goal 95% main sources of lead exposure for children. 80% 1-year-olds 80% 86% VT 2010 86% 78% US data not comparable 70% 70% • Safe Drinking Water 60% 64% 60% About 60 percent of Vermonters get their Increase % of homes with elevated radon levels 50% 50% drinking water from public water systems, which that have an operating radon mitigation system are routinely monitored for contamination from 40% 40% harmful bacteria, chemicals and radionuclides. 2020 Goal 35% 30% 2-year-olds 30% Everyone else gets their drinking water from VT 2010 * 28% private wells or springs, which homeowners US data not comparable 20% 20% should have periodically tested. 10% 10% Increase % of schools that have an indoor air quality • Healthy & Safe Schools management system 2000 2002 2004 2006 2008 2010 2006 2007 2008 2009 2010 2020 Goal 10% Children spend much of their time in school VT 2010 7% buildings and can be affected by chemical, US data not comparable Elevated Blood Lead Levels Home Radon Testing biological and physical hazards there. Of children age 1-5 tested for lead, # of children # of residences that have been tested for radon Environmental health management strategies Reduce % of children who have elevated blood lead levels KEY: with elevated blood lead levels (cumulative from 2000) can improve indoor air quality and reduce (≥ 10 µg/dl) 5–9 µg/dl hazardous exposures.

Environmental Health Environmental 91–100% • younger than age 6 2020 Goal 0% 10 µg/dl and more VT 2010 0.6% 2,742 • Radon US data not comparable 76–90% 45% 45% 2,406 Radon is a naturally occurring gas released from 40% 40%

2,248 bedrock. You cannot see, smell or taste radon, 2,185

61–75% 2,829 Reduce # of adults who have elevated blood lead levels 35% 35% but it is the second leading cause of lung cancer from work exposures 30% 30% 31–60% 2,284 after smoking. The only way to determine if (# per 100,000 employed adults) 2020 Goal 9.3 25% 25% radon is present in your home is to test for it. VT 2009 10.3 J 1,903 0–30% New homes can be built to be radon-resistant, US 2008 22.5 20% 1,513 20%

1,210 and older homes with elevated radon levels can 15% 15% 1,056

925 have mitigation systems installed. In Vermont, of 7,104 7,255 7,785 8,355 8,905 9,297 9,697

Reduce % of inspections that find critical food safety 10,514 12,009 14,212 15,488 10% 10% the approximately 15,500 homes that have ever violations 5% 5% 2020 Goal 35% been tested, one in 10 have elevated radon that VT 2010 43% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 should be mitigated. US data not available * During a followup study of 120 homes with elevated radon levels (≥4 pCi/L), 34 had installed radon mitigation systems. 32 Healthy Vermonters 2020 • Behaviors, Environment & Health 33 INDICATORS/GOALS Heart Disease & Stroke Deaths Heart Disease & Stroke Deaths Heart Disease/Stroke & Income • What is Heart Disease? J statistically better than US 8 statistically worse than US # per 100,000 people # per 100,000 people • 2010 4220.7 % of adults who have had heart disease or a stroke, More than 43,000 adult Vermonters have some 300 by Federal Poverty Level • 2010 form of cardiovascular disease. Nationally and Reduce coronary heart disease deaths U.S. 3517.9 in Vermont, death rates from heart disease and Vermont lower income greater income (# per 100,000 people) n men n women stroke have been declining steadily over the 2020 Goal 89.4 250 n heart disease stroke past several decades. Still, heart disease is the VT 2009 111.7 J second leading cause of death after cancer, US 2009 126.0 200 1208.9 9% Heart Disease and stroke is the fifth leading cause of death.

Reduce stroke deaths 150 (# per 100,000 people) • Preventing Heart Disease & Stroke 126.0 Mounting evidence suggests a relationship 2020 Goal 23.4 731.6 6% 100 111.7 between heart disease and environmental and VT 2009 29.3 J Goal: 89.4 5% Stroke psychosocial factors. Communities can help by US 2009 38.9 4% 4% 50 38.9 394.2 creating a healthy environment that supports 3% health-promoting behaviors. Access to fresh, Goal: 23.4 29.3 221.4 Reduce % of people with high blood pressure healthy and affordable food, safe and smoke- 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 45.5 20.2 1% 1% free places to gather and exercise may help • children younger than age 18 2020 Goal * * * Age < 65 65–74 75–84 85 + < 1¼ times 1¼ - 2½ times 2½ - 3½ times > 3½ times people reduce their risk for many chronic VT/US data not available Cholesterol Check & Income poverty level poverty level poverty level poverty level conditions, including heart disease. % of adults who have had their cholesterol checked within the past five years, • adults 2020 Goal 20% 41% J by Federal Poverty Level • 2010 Stroke Prevalence Heart Disease Prevalence • Preventing Heart Disease & Stroke (age 18+) VT 2009 25% % of adults who report being told by a physician % of adults who report being told by a Clinical preventive services have been shown US 2009 28% that they have had a stroke • 2010 physician that they have had a heart attack to lower risk of disease. These services include lower income greater income or heart disease • 2010 counseling to stop smoking, periodic blood 30% pressure and cholesterol screening, and Increase % of adults who have had their cholesterol Goal: 85% Heart Disease & Stroke checked in the past 5 years n men n women n men n women controlling high blood pressure and cholesterol. 2020 Goal 85% 82% 78% VT 2009 75% 73% 22% • Know Your Numbers! US 2009 76% 67% 19% About one-quarter of Vermonters have not had 16% their cholesterol checked in the past five years. All adults should know their cholesterol and 12% 11%11% blood pressure numbers, and how to keep them 10% 8% in control. Knowing the signs and symptoms of heart attack and stroke, calling 9-1-1 right away, 5% 5% 4% and getting timely treatment also saves lives. < 1¼ times 1¼ - 2½ times 2½ - 3½ times > 3½ times 1% 1% 1% poverty level poverty level poverty level poverty level Age < 65 65–74 75–84 85 + Age < 65 65–74 75–84 85 +

* age 8-17 years * * * goal to be developed 34 Healthy Vermonters 2020 • Diseases & Health Conditions 35 INDICATORS/GOALS Cancer Prevalence & Age/Gender Most Commonly Diagnosed Cancers • Cancer is Not One Disease, but Many J statistically better than US 8 statistically worse than US % of adults who report they have ever been diagnosed with cancer • 2010 % of all cancer diagnoses 2009, by type: n in women n in men Cancer is not one disease, but a group of more than 100 different diseases that often develop Reduce overall cancer deaths gradually as the result of a complex mix of Breast 29% Prostate 27% (# per 100,000 people) 2020 Goal 151.6 lifestyle, environment and genetic factors. VT 2009 168.4 n men n women 20% Cancer will affect all of us in some way. US 2007 178.4 Lung 15% Lung 14% Either we have had cancer ourselves, or we

Cancer 16% know someone who has. Increase % of cancer survivors who report – 15% 14% Colorectal 8% Colorectal 8% • Incidence & Mortality • excellent to good general health 2020 Goal 85% 11% Nearly one-half of all men and one-third of all VT 2010 76% Melanoma 8% Uterine 8% 8% US data not available (Skin) women will develop cancer in their lifetime. 6% Each year more than 3,500 Vermonters are • always or usually getting 2020 Goal 90% 3% Melanoma diagnosed with some form of cancer. Cancer has 2% 6% Bladder 7% emotional support VT 2010 83% 1% (Skin) overtaken heart disease, and is now the leading US data not available cause of death in Vermont. Each year, more than 18–44 45–54 55–64 65–74 75 + 1,200 Vermonters die from some form of cancer. Increase % of adults who receive recommended –

• cervical cancer screening 2020 Goal 95% Cancer Deaths Most Common Causes of Cancer Deaths • Risk Factors (women age 21+) VT 2010 84% # per 100,000 people % of all cancer deaths 2009, by type: n in women n in men Cancer occurs in people of all ages, but risk US 2010 83% increases significantly with age. Nearly two- thirds of cancer deaths in the U.S. can be linked • breast cancer screening 2020 Goal 95% 250 men Lung 30% Lung 30% to tobacco use, poor diet, obesity and lack of (women age 50-74) VT 2010 83% J physical activity. Not all cancers are preventable, 230 US 2010 80% Breast 13% Prostate 8% but risk for many can be reduced through a 210 205.8 healthy lifestyle. • colorectal cancer screening 2020 Goal 80% J 190 all adults (men and women age 50-75) VT 2010 71% Colorectal 9% Pancreatic 8% • Cancer is Survivable US 2010 63% 170 168.4 Cancer is most survivable when found and Pancreatic Colorectal 7% treated early. New and improved treatments are • discussion about PSA screening 150 Goal: 151.6 7% for prostate cancer with health care provider (men) women helping people live longer than ever before. 130 141.5 Liver/ The five-year survival rate is the percentage of Ovarian 4% 5% 2020 Goal * * * Intrahepatic people who live at least five years beyond the VT/US data not available 110 diagnosis. An estimated 29,000 Vermonters are 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 living with a current or previous diagnosis of cancer.

* * * goal to be developed 36 Healthy Vermonters 2020 • Diseases & Health Conditions 37 • Breast Cancer Mammograms & Income Pap Test & Income Colorectal Screening & Income Cancer Survivors’ Health & Income • Prostate Cancer In Vermont, breast cancer is the most commonly % of women age 50-74 who report having a mammogram in % of women age 21+ who report having a Pap test in past 3 years, % of adults age 50-75 who report having been screened In 2010, % of cancer survivors who report that – Prostate cancer is the most common cancer diagnosed cancer in women, with about 500 past 2 years, by Federal Poverty Level • 2010 by Federal Poverty Level • 2010 for colorectal cancer in the past 5 years • 2010 diagnosed among Vermont men. Each year women diagnosed each year. The breast cancer more than 500 men are diagnosed, and nearly death rate has decreased since the 1990s. Still, lower income greater income lower income greater income lower income greater income lower income greater income 60 die from the disease. Having a frank and each year, about 80 women die from breast detailed discussion with a primary care provider cancer. Goal: 95% Goal: 95% about possible harms and benefits of screening … their general health is 89% 78% excellent to good— or treatment is essential for making an informed 85% 88% Because incidence of breast cancer increases 85% 82% 71% decision. 76% 79% with age, women age 50 to 74 should have a 73% 61% mammogram every two years. Women who 59% • Colorectal Cancer have had breast cancer or have a mother, sister 87% Colorectal cancer kills more Vermonters than any or daughter with breast cancer have a greater other cancer except lung cancer. Each year, ap- risk. Risk may also be related to hormones and 59% proximately 300 people are diagnosed, and 100 diet. Women under age 50 who are at higher die from the disease. Colorectal cancer risk due to personal or family history should dis- develops slowly, so early diagnosis often leads to cuss screening with their health care provider. < 1¼ times > 3½ times a complete cure. Screening is recommended for poverty level poverty level < 1¼ times 1¼ - 2½ times 2½ - 3½ times > 3½ times < 1¼ times 1¼ - 2½ times 2½ - 3½ times > 3½ times < 1¼ times 1¼ - 2½ times 2½ - 3½ times > 3½ times everyone age 50 to 75 years old. Mammography, combined with a clinical breast poverty level poverty level poverty level poverty level poverty level poverty level poverty level poverty level poverty level poverty level poverty level poverty level exam, is still the most effective means of early • Living With and Beyond Cancer Colorectal Cancer Screening & Health Care they get the emotional/ psychological detection. In Vermont, the majority of breast Breast Cancer Screening Cervical Cancer Screening help they need— Living with cancer can affect all aspects of a cancers are diagnosed at the localized stage – % of women age 50-74 who have had a mammogram in the past % of women age 21+ who have had a Pap test in the past 3 years % of adults age 50-75 who report having been screened for person’s life. Emotional, psychological, physical, colorectal cancer in the past 5 years • 2010 the most treatable stage before the cancer has 2 years 92% financial and social support are all equally vital to spread. Still, screening is underutilized. restoring a person’s quality of life. 100% 100% Goal: 95% Goal: 95% • Cervical Cancer 90% 83% 90% 84% 64% • Cancer Disparities Some cervical cancers result from infection with 80% 80% 83% Nationally, white non-Hispanics have a higher 80% 73% 73% one of the strains of HPV, the human papilloma 70% 70% risk for female breast, melanoma and bladder virus. In Vermont each year, about 16 women 60% 60% cancer, and lower risk for prostate, colorectal and are diagnosed and four die from the disease. cervical cancer than people of racial or 50% Vermont 50% Vermont < 1¼ times > 3½ times Cervical cancers do not form suddenly. HPV 40% ethnic minority groups. In Vermont, white non- 40% 40% 35% poverty level poverty level vaccination, early detection through Pap tests, U.S. U.S. Hispanics are more likely to die from cancer and treatment of pre-cancerous lesions make 30% 30% (169.2 deaths per 100,000 people) than people deaths from cervical cancer almost entirely 20% 20% of racial or ethnic minority groups (103.7 per preventable. The HPV vaccine doesn’t protect 10% 10% Those who have a Those with NO Those who have Those with NO 100,000). against all strains, so women should start having personal doctor personal doctor health insurance health insurance regular Pap tests at age 21. 2000 2002 2004 2006 2008 2010 2000 2002 2004 2006 2008 2010

38 Health Status of Vermonters • Diseases & Health Conditions 39 INDICATORS/GOALS Projected Prevalence of Diabetes Diabetes-related Deaths Diabetes & Weight • Diabetes is Linked to Obesity J statistically better than US 8 statistically worse than US % of adults who have diabetes # per 100,000 people In 2010, % of adults who have diabetes, among — The growing prevalence of Type 2 diabetes is linked to the obesity epidemic. About 95% of Increase % of people with diabetes who have – 15% diabetes is Type 2, which can be prevented, 100 delayed or better managed with healthy eat- • diabetes education 2020 Goal 60% 12% 90 ing and physical activity. An estimated 50,000 VT 2010 51% 11% 17% 80 Vermonters have diabetes, and 130,000 have US 2008 57% 84.1 pre-diabetes and are at risk of developing the 9% 70 • blood pressure under control VT/2020 Goal * * * 60 disease. Yet more than one-quarter of those Diabetes with diabetes, and more than three-quarters US 2005-08 52% 50 6% 7% with pre-diabetes have not yet been diagnosed. • annual dilated eye exam 2020 Goal 60% 40 VT 2010 51% 30 6% • Who is at Risk? 3% US 2008 53% 20 Overweight and inactivity, having high blood 2% 10 pressure, high cholesterol, being age 45 and • an A1C* value of less than 7% VT/2020 Goal * * * Healthy-weight Overweight Obese older, or having a family history of diabetes puts US 2005-08 54% 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050 2001 2003 2005 2007 2009 or underweight Vermonters Vermonters Vermonters a person at risk of developing diabetes – as well as women who have had gestational diabetes, Reduce the rate of new cases of end-stage renal disease (# per million people) Clinical Care for Diabetes Diabetes Hospitalizations Diabetes & Income delivered a baby over nine pounds, or have 2020 Goal 200.0 % of adults with diabetes who report they have medical care that meets clinical guidelines • 2010 # per 10,000 people % of adults who have diabetes, by Federal Poverty Level • 2010 had polycystic ovary syndrome. In Vermont, VT 2009 222.0 J people of racial and ethnic minority groups are US 2007 353.8 at greater risk (9%), compared to white non- 89% Hispanics (6%). 82% 75% Goal lower income greater income • Diabetes Education is Key 60% 60% 6 Only a little more than half of Vermonters who 63% 61% have diabetes have ever had formal education 5 about screening, treatment and self-manage- 51% 51% 11% 4 4.7 ment, yet having these skills can reduce many 9% 3 serious and life-threatening complications, and 6% improve quality of life. 2 5% 1 • Chronic Kidney Disease Diabetes is the most common cause of chronic < 1¼ times 1¼ - 2½ times 2½ - 3½ times > 3½ times 2001 2003 2005 2007 2009 poverty level poverty level poverty level poverty level kidney disease that can progress to kidney Cholesterol Foot A1C Pneumonia Flu Dilated eye Diabetes failure. check exam test shot shot exam education once/yr. once/yr. twice/yr. ever once/yr. once/yr. ever

* A1C is a measure of diabetes control * * * Vermont data not available and goal to be developed 40 Healthy Vermonters 2020 • Diseases & Health Conditions 41 INDICATORS/GOALS Asthma Hospitalizations Emergency Dept. Visits for Asthma Asthma Prevalence • Asthma J statistically better than US 8 statistically worse than US # of hospital discharges per 10,000 people # visits to the ED per 10,000 people • 2009 * % of adults who currently have asthma Asthma is a serious chronic disease that inflames and narrows the airways in the lungs, Reduce hospitalizations for asthma (# per 10,000 people) 25 n male n female and can cause recurring attacks of wheezing, younger than 5 94.0 15% chest tightness, shortness of breath and cough- • children under age 5 2020 Goal 14.0 19.0 ing. Asthma affects people of all ages, but it VT 2009 19.0 J 20 11.1% most often starts during childhood. In Vermont, US 2007 41.4 about 67,000 people are known to have asthma. 15 10% Nearly 13,000 of them are children. Between • age 5-64 2020 Goal 4.2 55.5 VT 2009 4.9 J 11.8 46.8 1980 and 1994, the prevalence of asthma in the 41.5 40.3 U.S. increased by 75%. US 2007 11.1 10 65 years old + 29.3 5% • age 65+ 2020 Goal 9.3 6.7 21.0 • Reduce Hospitalizations for Asthma 16.2 VT 2009 11.8 J 5 Utilization of acute inpatient care for asthma is US 2007 25.3 total population an indicator of the health of Vermonters who have asthma. Asthma hospitalizations have Increase % of people with asthma who have a written Age < 5 5–17 18–64 65+ 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 been declining over time with improved clinical asthma management plan from a health care provider – care and patients following treatment guide- lines, and may be due also to efforts to mitigate • children younger than 18 2020 Goal 65% Asthma & Chronic Disease Respiratory Disease & Income Smoking Bans VT 2010 48% % of adults who have asthma, among those who have– % of adults who have asthma or chronic obstructive pulmonary % of adults who report they have smoking bans at home to protect the environmental triggers that can exacerbate disease, by Federal Poverty Level • 2010 against exposure to secondhand smoke • 2010 asthma.

Respiratory Disease • adults age 18+ 2020 Goal 40% lower income greater income Lung Disease • Importance of an Asthma Action Plan VT 2010 32% 37% (COPD) 15% smokers non-smokers People with asthma should routinely check US data not comparable Depression 26% 13% in with their health care provider and have an asthma action plan to help identify triggers in 10% Increase % of people with asthma who have been advised Diabetes 17% 9% 72% 94% the environment to change or avoid, recognize to make changes at home, school and work – Asthma with children symptoms, and know when and how to use Obesity 16% medications and seek medical attention. • children younger than 18 2020 Goal 50% VT 2010 33% Arthritis 14% 48% 89% • Zero Exposure to Secondhand Smoke There is no safe exposure to tobacco smoke, • adults age 18+ 2020 Goal 45% Current Smoker 16% VT 2010 35% 6% without children especially for children. A growing number of

COPD 3% adults, both smokers and nonsmokers, have US data not comparable 11% of all adults have asthma 2% 2% instituted smoking bans at home and in the car. < 1¼ times 1¼ - 2½ times 2½ - 3½ times > 3½ times Reduce % of adult non-smokers poverty level poverty level poverty level poverty level exposed to secondhand smoke 2020 Goal 30% VT 2010 43% US data not comparable * all visits for asthma that did not result in hospitalization 42 Healthy Vermonters 2020 • Diseases & Health Conditions 43

INDICATORS/GOALS Arthritis & Age Arthritis & Weight Prevalence of Hip Fractures • What is Arthritis and Who Has It? J statistically better than US 8 statistically worse than US % of adults who have doctor-diagnosed arthritis, by age • 2006-2009 % of adults who have arthritis, by weight as measured by # of hospital discharges for hip fractures among Vermonters The term arthritis is used to describe more than Body Mass Index (BMI) • 2009 age 65+ per 1,000 people • 2009 100 conditions that affect the joints and tissues, Reduce % of adults with diagnosed arthritis n men 36% including osteoarthritis, rheumatoid arthritis, who have limitations in their activity n women lupus, carpal tunnel syndrome, fibromyalgia 8.5 30% and gout. Osteoarthritis is the most common 2020 Goal 40% form of arthritis, and the most common cause VT 2009 45% age 12% of disability. As the population ages, the number US 2008 45% 23% women 18–44 12% of adults with doctor-diagnosed arthritis and Increase % of adults with diagnosed arthritis limitations in activity is likely to grow steadily who receive – 3.8 through 2030.

• counseling on physical activity 2020 Goal 65% men People who are overweight or obese are more VT 2003 58% age 27% likely to have arthritis compared to those who US data not comparable 45–54 are normal weight or underweight. Contrary to 30% national statistics, in Vermont arthritis is more • arthritis education 2020 Goal 15% Healthy weight Overweight Obese common among racial and ethnic minorities VT 2003 12% or underweight (31%) than among white non-Hispanics (25%). US data not comparable Osteoporosis by Age/Gender Reduce % of adults age 50+ who have osteoporosis age 40% % of adults ever diagnosed with osteoporosis • 2007 • What is Osteoporosis and Who Has It? Osteoporosis is a thinning of bone tissue and 55–64 45% 2020 Goal 10% age 45–64 age 65+ loss of bone density over time. About 12% of VT 2007 12% adult Vermonters have been diagnosed, with US data not comparable highest rates among older women.

47% men • Prevention, Treatment and Management age Maintaining a healthy weight, not smoking,

Arthritis & Osteoporosis 3% 65–74 59% 2% avoiding excessive alcohol use, adequate intake of calcium and vitamin D, physical activity, strength training and weight bearing exercise promotes bone health and helps to prevent disease. Physical activity helps control the joint age 50% swelling and pain of arthritis. Early diagnosis, women 26% 75+ 64% 11% treatment and appropriate self-management can slow progression of disease, depression, ease fatigue, and improve quality of life.

44 Healthy Vermonters 2020 • Diseases & Health Conditions 45 INDICATORS/GOALS Youth Sexual Behavior Condom Use by Adults HIV Testing • HIV and AIDS J statistically better than US 8 statistically worse than US among 9th-12 graders, by self-report • 2011 % who used condoms among adults who have had sex in the % of adults age 18-64 who report they have been tested for HIV HIV is a serious infection that, without treat- past 12 months, by number of sex partners • 2008 in the past 12 months ment, can lead to AIDS and early death. Increase % of sexually active people who use condoms 4 % Sexually active within last 3 months — The number of people living with HIV in the 9 % used a condom U.S. is nearly 1.2 million, with about 50,000 new • females grades 9-12 2020 Goal 65% 15% did not use a condom cases diagnosed each year. At the close of 2010, VT 2011 58% 6 % 71% 70% 238 Vermonters were known to be living with US 2011 54% Not sexually active within last 3 months 65% AIDS, and 161 were known to be living with HIV.

never had sex: 8 % An estimated 100 more are living with the virus, • females age 18-44 2020 Goal 45% 81 % 10% VT 2008 41% 17 % but are unaware. US data not comparable • Know Your HIV Status • males grades 9-12 2020 Goal 75% Grade 9 9 % Most people don’t know that it can take, never had sex: 14 % 5% VT 2011 68% 66 % 5% on average, 11 years for HIV infection to develop US 2011 67% 17% into AIDS. Early diagnosis and treatment can improve health and years of life for people with • males age 18-44 2020 Goal 65% never had 25 % Grade 10 sex: 51 % 1 partner 2 partners 3 partners 4+ partners 0 HIV, and keep the virus from infecting others. VT 2008 59% 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 22 % HIV is now considered a survivable chronic US data not comparable 11 % Chlamydia Diagnoses Chlamydia by Age illness, and everyone who is sexually active never had should be tested. In Vermont, 15% of people Increase % of people tested for HIV sex: 39 % # of cases reported to the Vermont Department of Health # of cases reported, by age group • 2010 HIV, AIDS & STDs HIV, Grade 11 of racial and ethnic minorities have been tested, • youth younger than age 18 2020 Goal 15% compared to 6% of white non-Hispanics. (ever tested) VT 2011 10% 12 % 28 % US data not available 1400 1,268 773 • Preventing Sexually Transmitted Diseases Grade 12 1200 Fewer than 25% of all sexually active Vermont- • adults age 18-64 2020 Goal 10% ers age 18 to 64 who engage in behaviors that (tested past 12 months) VT 2010 5% 8 1000 put them at risk for HIV report using a condom. US 2010 10% HIV & AIDS Diagnoses # of newly diagnosed cases statewide each year In Vermont, adults of racial and ethnic minority 800 groups are more likely to use a condom (24%), Reduce # of new HIV diagnoses 2020 Goal 5 364 compared to white non-Hispanics (15%). (5-year average) VT 2006-10 9 600 US data not available • Chlamydia 400 Reduce % of females age 15-24 with chlamydia infection AIDS - 22 AIDS - 18 AIDS - 13 Every year in Vermont, an estimated 5,000 peo- AIDS - 8 AIDS - 16 AIDS - 6 ple are infected with chlamydia, yet only about 200 119 2020 Goal 1.0% HIV - 10 HIV - 10 HIV - 11 HIV - 13 HIV - 10 12 1,200 cases are diagnosed, treated and reported HIV - 5 VT 2010 1.6% J 0 to the Health Department. Left untreated, US 2008 7.4% 2000 2002 2004 2006 2008 2010 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 < 18 18–24 25–44 45–64 65+ chlamydia can lead to Pelvic Inflammatory Disease and infertility.

46 Healthy Vermonters 2020 • Diseases & Health Conditions 47 INDICATORS/GOALS • Prepared to Respond Vermont’s Public Health J statistically better than US 8 statistically worse than US Public health emergencies can affect the Emergency Response Healthy Vermonters 2010 • Report Card DECREASE % OF – lives of all Vermonters. When responding to J adults who smoke cigarettes infectious disease oubreaks, natural or man- • 2000 Preparedness planning Following are Healthy Vermonters goals that were set in 2000 for the decade J youth who smoke cigarettes Reduce the time it takes for the state public health agency – made disasters or environmental hazards, • 2001 Sept. 11 attacks ahead, with a report on progress made by 2010 denoted by: youth who use spit tobacco the Vermont Department of Health must be • to activate designated personnel in response • 2002 Anthrax threats 4 met goal J statistically better than US 8 statistically worse than US youth who smoke cigars, cigarillos, little cigars to a public health emergency prepared to respond quickly and effectively, KI distribution youth who binge drink along with government, the health sector, 2020 Goal 60 min. Smallpox vaccinations 8 youth who use marijuana and community partners. VT 2009 66 min. • 2004 Pneumonic plague Behaviors, Environment & Health youth who used alcohol before age 13 US 2009 66 min. exercise (1 week) One measure of preparedness is the ability Flu vaccine shortage • to issue official information about a public health emergency to activate designated personnel within INCREASE % OF – REDUCE RATE OF – • 2005 Pandemic flu planning 4 J youth who engage in regular physical activity 4 alcohol-related motor vehicle deaths one hour of a recognized public health Hurricane relief efforts 2020 Goal 60 min. emergency. 4 J adults who engage in regular physical activity work-related injuries resulting in medical treatment, lost time from VT data not available • 2006 Pandemic flu summits youth who eat 2+ servings of fruit/day work, or restricted work activity Pandemic flu exercise US data not available • Prepared to Inform J adults who eat 2+ servings of fruit/day residential fire deaths (2 weeks) youth who eat 3+ servings of vegetables/day child abuse substantiated cases • to establish after-action reports and improvement plans Rapid release of accurate information can Tire burn surveillance J adults who eat 3+ servings of vegetables/day 4 J following responses to public health emergencies and exercises minimize rumors and incorrect information, • 2007 Pandemic flu exercises physical assaults by intimate partners and empower people to make good KI distribution adults who have food security eliminate elevated blood lead levels in children age 1-5 2020 Goal 40 days decisions and take positive actions to J adults who attempt to quit smoking 8 • 2008 Hospital surge exercise VT 2008/09 60 days protect themselves and others. The structure Flood response pregnant women who quit smoking during first trimester US 2009 46 days and tone of risk communication messages Pandemic flu ‘Take the Lead’ 4 smokers with children who don’t allow smoking at home Providing for Better Public Health is as important as timeliness. These • 2009 H1N1 flu/vaccination clinics 4 smokers with children who don’t allow smoking in their car messages differ from day-to-day health Increase % of crisis and emergency risk messages to protect Empire ‘09 dirty bomb adults who always use safety belts INCREASE % OF – communication, and must be tailored to the ingestion pathway exercise youth who always use safety belts 4 J adults with a usual primary care provider public health that demonstrate use of best practices * * * event, using proven crisis and emergency (1 week) 1-year-olds who have had a blood lead test people who have health insurance risk communication principles. • 2010 Vermont Yankee tritium leak 2-year-olds who have had a blood lead test J pregnant women who receive prenatal care in first trimester CatEx hurricane exercise J • Prepared to Recover and Improve population on systems that meet safe drinking water standards pregnant women who receive early and adequate prenatal care (3 days) adults who live in homes that have been tested for radon children who receive universally recommended vaccines After every real event and exercise, a review • 2011 Spring flooding

Public Health Preparedness 8 children who receive varicella vaccine process is imperative to learn what we can Fukushima response DECREASE % OF – adults who receive annual influenza immunizations do better in the future. The After Action Hurricane Irene flooding 4 J adults who have NO leisure time physical activity J Review/Improvement Process is structured • 2012 Radiological emergency adults who have ever been vaccinated against pneumoccal disease 4 J to help assess strengths and areas for training/exercises (1 week) youth who watch TV or use a computer 5+ hours/day adults who use the dental health system each year J improvement soon after any response and Hurricane Sandy adults who are obese 4 children who get dental sealants recovery effort. Pertussis outbreak youth who are obese or overweight population served by fluoridated community public water systems Tdap vaccine clinics WIC participants age 2-5 who are overweight dentists who counsel patients to quit smoking

* * * data and goal to be developed Healthy Vermonters 2010 Report Card 48 Healthy Vermonters 2020 • Public Health Preparedness 49 DECREASE % OF – INCREASE % OF people with diabetes who – J low birth weight births receive diabetes education J very low birth weight births have an annual dilated eye exam 4 children who have ever had decay 4 have A1C test at least twice a year 4 children who had untreated decay J have a foot exam at least once a year J suicide attempts by youth had a flu shot in past 12 months 4 J have ever had a pneumonia vaccination REDUCE RATE OF – 4 J have had cholesterol measured at least once in past year infant deaths 4 J pregnancies among girls age 15-17 INCREASE % OF people with asthma who receive – 4 pneumonia/influenza hospitalizations among adults age 65+ patient education with info about community/self-help resources 4 reduce or eliminate vaccine-preventable diseases: Hib B, Measles, written asthma management plans .from their health care provider Rubella, Hepatitis B reduce or eliminate vaccine-preventable diseases: Pertussis INCREASE % OF people with chronic joint symptoms – suicide deaths 4 who have seen a health care provider for their symptoms

INCREASE % OF adults with doctor-diagnosed arthritis who have – Chronic Diseases & Health Conditions received effective, evidence-based arthritis education received counseling on weight reduction (for overweight/obese adults) INCREASE % OF – counseling on physical activity adults who have had their cholesterol checked within the past 5 years 4 J women age 40+ who have had a mammogram in the past 2 years DECREASE % OF – women age 18+ who have had a Pap test in the past 3 years adults with high blood pressure 8 adults who have had a FOBT in the past 2 years 4 children who are regularly exposed to tobacco smoke at home 4 J adults age 50+ who have ever had a sigmoidoscopy or colonoscopy adults exposed to tobacco smoke at home during past 7 days adults who take protective measures to reduce risk of skin cancer adults with arthritis who are limited in their ability to work adults with disabilities who have sufficient emotional support sexually active unmarried people age 18-44 who use condoms REDUCE RATE OF – youth who have never had sexual intercourse 4 J coronary heart disease deaths 4 sexually experienced youth who are not currently sexually active 4 J stroke deaths sexually active youth who used a condom the last time they had sex 8 diabetes deaths 4 J hospitalizations for uncontrolled diabetes among adults 8 COPD deaths among people age 45+ 4 asthma hospitalizations among people under age 18

50 Healthy Vermonters 2010 Report Card January 2013