 All right, committee we're back after a short break and we are taking up age 210 that came to us from the house and we have representative leopard here to introduce the bill to us so. Welcome representative leopard I know this is a bill critically important to you and I think it's going to be important to us as well so please. Introduce yourself for the record and welcome your input. Thank you. Good morning everyone represented bill leopard chair of the house health care committee and was I was the presenter of age 210 on the floor of the house. So I'm going to give a brief overview of the bill. And then I may. I'm also our committee is also of course taking testimony this morning so I may not stay for the entire time, but catch up with you all later. But let me say that yes to age 210 which is an act addressing health disparities and working toward issues of health equity is a bill that has. That our committee the house health care committee spent a great deal of time with and it's an important bill from in moving forward toward the kind of health equity issues that we believe are critical for all of our monitors. I want to acknowledge at the outset that while I was personally interested in beginning to address the issue of health disparities in our committee. We were there we were. We took up age 210 which was initially crafted by members of the affected communities and particularly from the Vermont racial justice alliance and introduced by representative Brian China as the lead sponsor. The bill is introduced. Really focused on addressing creating creating infrastructure, I would describe it as an effort infrastructure for addressing issues of health disparities. We have a long section of findings, which we. We've seen that sometimes findings are not seen as essential to a bill but in this instance it was very important for us to share with our colleagues. Findings which are each one of the findings is anchored in documentation from either the Department of Health or other sources and so we integrated the documentation into the findings so and there is also a separate single sheet with a series of links that could be made available to your committee. I'm sorry, I didn't think that was available to you today, but we found it of use, because in each of the findings there's a document, and there's a link that you can go directly to that document. These findings really anger the bill in terms of issues of health disparities around race and ethnicity. The LGBTQ community and the disabilities people with Vermonters with disabilities. We know that COVID, the COVID pandemic has made painfully clear the level of health disparities we have in Vermont, particularly around COVID and race and ethnicity. What the again coming back at the bills introduced immediately would have established an office of health equity within the Department of Health. Given the health departments 24 seven involvement in the pandemic. It was our conclusion that at this point in time, it was probably not realistic to ask the health department to take on a new initiative, even though this bill aligns very strongly with the health equity work that the Health Department of Health has been doing for a number of years. And so, while the bill asked to have an office of health equity established immediately it also called for the establishment of an advisory commission. And we made a decision in consultation with the office of racial equity and the director of racial equity who's here to join us to think about how to not simply not move forward because if we couldn't establish an office immediately. Instead, look to establish the commission and to empower the affected communities who are the primary members of the commission. And to, and I want to say express our gratitude for the willingness of the office of racial equity and Susanna Davis as the director to take to contemplate taking on a transitional role of standing up the commission. And then, using the commission to actually help think further about establishing the office of racial equity, as well as looking to help establish how we should move forward with cultural competency training for all health care professionals, as well as taking on its role of advising the general assembly and advising the Department of Health as well. There's also a data component. And again we in was it House bill 315 we actually appropriated some separate dollars as well for issues of data collection and alignment, because both proper collection of data around these issues, as well as should be to ensure that data is collected and to ensure that it's the proper kind of data that it's not that it's disaggregated and it's not, and that it should be studied and reported on on a regular basis. I would say that the structure of the commission is more unusual than usual typically has is a large number but it has many members of the affected communities as well as representatives of the state. And within the commission, we, we asked for an appropriation. Well, let me back up and say that it would not have been realistic, nor appropriate to ask for the office of racial equity to take on this transitional role. And there not been also a commitment to the staffing of two additional positions in the office of racial equity, which now I believe is reflected in the House budget on an ongoing basis. And we advocated for that and said if that was not in place we wouldn't ask for any treasure transitional role, but it was also not appropriate to give to ask for this transitional role without additional resources. So $180,000 is appropriated for the next fiscal year to support the director of racial equity. To hire in a manner that's determined by that office staffing or consultants to help stand up the commission as well as to provide the support for the commission in its initial work as I've outlined it. I think the underlying issue, the underlying dynamic that we hope is reflected here is to elevate the voices of the affected communities to empower those voices those members to have a significant role in moving forward with developing the infrastructure to address health disparities. And we recognize that this bill is in many ways modest in nature, and yet very significant in trying to establish infrastructure that will allow health disparities to begin to be mitigated and address significantly over time. I think with that, that's my general introduction to the bill. We are very pleased you're taking up the bill today. And we look forward to working collaboratively along the way, if there are ways to strengthen the bill. Thank you. That's very helpful. And, and obviously I know we've both been through some dip our both of our committees have been through some difficult times with the pandemic and one of the. We'll share with folks because some of our committee members are new but one of the first things that we did during our discussion and our legislative work was to add in racial and ethnic disparity data collection for COVID. And that has, I think, been an underpinning for a great deal of the work that continues to go on in the Department of Health and we're, we're, we are actually proud of that one. But this one seems like this bill will take us a giant steps forward. So, you know, thanks for your work on this so we really appreciate it. And the question I have for you is, what was the vote out of committee. Oh, it just something. I think the vote out of committee would we. So just to put it in context, we have one member who is in leadership in the house and is does not participate in the committee so there's always one person absent. So it, but it was a nine one vote. One nine nine one opposed and one absent. And then how about the floor was it a voice vote or it was a voice vote it was very strong voice vote. Okay. And anything else whether whether folks who testified who were categorically against the bill in any way or we're requesting specific. It would be fair to say, well, first of all, we heard from many members of the affected communities and that those, those were the voices that were most powerful for us to hear. And both from the disabilities community from, we heard from the racial justice alliance we heard from the LGBTQ community we heard from the Abenaki community. And for those who feel like the bill should have been strengthened further by having an immediate establishment in the office of health equity, and that we should have immediately required training for health professionals. It was our determination that the it was not, we were not going to be able to establish that office immediately. If you determine otherwise, we certainly would support that. So I think there are those who would see the bill as wishing it had been enacted as introduced. But I think there were many people who also see this as a significant step. Yeah, okay. Yes, I can. Did you did you hear from the Department of Health on the open? We did. We heard from the Department of Health initially and one of the things that was most striking immediately was how, how in alignment the structure of the bill was with the work of the health equity work of the department and How do you climb it? But what testified and and we were both impressed and heartened by the efforts that have been put in place. But it also was clear that there was more that needed to happen. I would also just say that the initial I think the initial absence of race data. In terms of COVID was both an indicator of where of why we need why we need to do more. That that wasn't in place initially was an indicator of the exactly the challenges that we're facing. The structural failure to include race data. And, but then the subsequent commitment to making it. Available and using that analysis, which then led to the understanding of the disparities without the actual data collected. We can't fully understand where the disparities lie. Okay, thank you hamstrings us from taking steps for further. Yeah. Okay. Committee questions for representative Lippert. Go ahead, Senator Hooker. Thank you. Thank you. And thank you representative Lippert for bringing this forward. My question is with regard to an office of racial disparities. Do you anticipate it. Office of racial equity. Great equity. Thank you. Do you anticipate it being eventually in the department of health? Well, interestingly enough, as the bill is introduced, made it clear that it should be in the department of health testimony that we heard from. Well, we heard from the office of healthcare advocate, as well as hearing from Suzanne Davis as the director of racial equity. Well, she can speak for herself, but obviously there are different different views as to where and how the office should be located the bill introduced as says it should be in the office of in the department of health. We allowed for the commission to recommend how that should move forward, rather than us saying in statute at this point in time. Because there are there are clear advantages. Some feel that there are advantages for being an independent office such as the office of the health care advocate outside of state government. And others feel like there should be it should be within state government. I may have a personal view at this point, but the committee did not take a position. And I think there are a lot of reasons why being working within state government allows you to have a powerful access and influence, but it also could also at times have a challenge in terms of working within a structure that you may want to advocate to change or influence. So the bill itself allows the commission specifically to give direction on that. Thank you. Which I think is actually appropriate in terms of having the affected communities, which did help to introduce the bill, but at this point I also think once the commission is in panel to give them the ability to speak to that issue. Senator Hardy. Thank you, Madam chair, and thanks representative Lippert for being here. And I just scrolling through the bill there are 11 pages of findings which I think is the most findings I've ever seen in a bill. You mentioned. There's lots to find. You mentioned that there was some document that goes with it that has hot links to sources. Could you send that along to. I will make sure that sent out fact out. When I get back to my screen in my zoom room. I will ask to have that sent to you. And just to say, you know, let me acknowledge that there were some challenging questions asked. Not everyone at the vast, vast, vast majority of our committee strongly supported this bill. We believe that we this is a part of addressing issues of structural racism as well as broader disparities. Not, we found that there was some disagreement. And while I say, we had the vast majority we had a strong vote of nine members of our committee supporting this bill. We believe the findings anchor the very facts of health disparities. And for some members we felt it was important in taking this to the floor of the house that there might be some members who question this. And while our committee doesn't question this. It was it was really an attempt to anchor the information in data. In addition to the anecdotal powerful anecdotal testimony as well and I don't mean to demean that by saying anecdotal. But we've learned that data in addition to the lived experience and stories of individuals affected directly. That becomes a powerful combination. And so that's why it is unusual long unusually long set of findings, but we felt it was essential. Okay, thank you. All right, unless there are other questions for representative lipid I'm going to suggest that we ask Katie McClinn to walk us through the bill and then we'll hear from Susanna Davis and Susanna. If you feel that your time is starting to run away. Let me know please just raise your hand or send me a chat. And we can we'll interrupt the bill and we'll and we'll we'll hear from you but I thought it might be helpful for us to look at the bill first. Thank you very much. Okay. Senator Lyons, Katie and Susanna other committee members. I mean no disrespect but I think I need to go back to my committee. And so I will follow up and make sure I understand what your discussion is here this morning and the further testimony, but I appreciate you taking up the bill and I look forward to us working together on it. Okay, thank you. Thank you very much. And then, okay, so Katie I know that you have a your, your between between shows. We have a hard stop at 11 so we'll we'll go into the bill and I think, I think rather than read each, each finding and each section of the bill to give us the more of a 2000 foot level, just so we understand what is here, and I, we, we will definitely hear more testimony and take some time to go through the bill more thoroughly as we continue our work on it. Let me pull up my screen. There we go. Are you seeing to 10. Okay, I see had not in great. So as representative Lippert said, the first section is the finding section, and I'm just going to scroll through it for today. And it sounds like we'll come back to this at another point. I think maybe there are some there may be some things that are that should be highlighted and a few. I can see what most of them are and I think we've read most of it already but I can tell you that the findings are broken down and part into categories because this bill focuses on health health equity of various populations so there. There is a section of findings on LGBTQ adults and also on LGBTQ youth there are findings organized by race and ethnicity there are findings organized by Vermonters with disabilities so the finding section makes an effort to provide statistics on the various about various populations and communities impacted by this by this bill. Section two of the bill is on page 10. And this is a legislative intent and purpose section I'll go through this, that it's the intent of the General Assembly to promote health and achieve health equity by eliminating avoidable and unjust disparities and health. It's an economic and comprehensive approach to address social economic and environmental factors that influence health. To this end, the General Assembly believes that equal opportunity is a fundamental principle of American democracy equal enjoyment of the highest attainment attainable standard of health as a human right and a priority in the state. A structural racism defined as the laws policies institutional practices cultural representations and other societal norms that often work together to deny equal opportunity has resulted in health disparities among Vermonters. Great social costs arise from these inequities including threats to economic development democracy and social health of the state of Vermont. Section four, the General Assembly believes that health disparities are a function of not only access to health care, but also social determinants of health including the environment, the physical structure of communities nutrition and food options, educational attainment employment race, ethnicity, sex, geography language preference immigration or citizen status, sexual orientation gender identity and socioeconomic status. You want me to move through this more quickly. No, no, no, I don't I want to go back to number four very briefly. Yeah, no, I was going to ask a question about the, it says social determinants of health, including. But I'm not sure whether that the including relates to social determinants of health because the what follows or not social determinants of health. I'm just thinking that we may want to clear that I'm just pointing that out right now so we may want to clarify the meaning of that paragraph and to clarify what specifically our social determinants of health and what are not. Okay. Okay. I will flag that thank you. Thank you. In Division five the General Assembly believes that efforts to improve health in the US have traditionally looked at the health care system as the key driver of health and health outcomes. However, there has been increased recognition that improving health and achieving health equity will require broader approaches that address factors that influence health. And lastly, the General Assembly believes that health equity is the attainment of the highest level of health for all people. Health equity can be achieved only by eliminating the preventable differences in the health of one group over another, as the result of factors such as orientation, gender, disability, age, socioeconomic status or geographic location. And then we have a purpose section. The purpose is to eliminate disparities and question. I don't know much, but I just want to highlight some areas that I think our committee from the health and welfare from the health and welfare perspective so it goes into disability and age and then it says socioeconomic status or geographic location, which might suggest the health and improvement plan process, or the hrap that we see. So this could, I'm just, I'm just wanting to have a firm understanding of what is implied by socioeconomic status and geographic location and what the extent will be considered. When we get to the commission. That's all. It's just a question, and we'll come back to it. Is somebody say something. Yeah, it's, it's an go for it. No, just wondering, when it says socioeconomic status. I'm just going back to my old, you know, sociology tests. Are we going to be looking at socioeconomic status. On BIPOC people. What I'm wondering is, is health status more function of ethnicity race, or is, is it as much a function of poverty, or life, you know, and because if we're going, I think we need to know what we're going to attack to fix it. Okay, this is a Senator, I think this is a question that now we have recorded and as we go through and hear from folks, it'll be one to bring up and I think there are people probably on on YouTube with us now on zoom with us looking at what we'll be able to respond to your question and that's why I'm raising these questions as we go forward. So either Susanna can help us, or as we go through the bill further we'll be able to get some clarification. Okay. And I would just. Senator Cummings refer you back also to the findings I think the, the potential witnesses that you will hear will probably have great responses to that question. I'm referring back to the findings there's a lot of tie in particularly with the findings with regard to housing conditions for persons who are black indigenous and persons of color, and that tie in with socioeconomic status so that's I'm just wondering if as a balance that we would also look at her non persons of color and do people in the same socioeconomic status have the same health outcomes, you know just trying to get at what is the root cause. Otherwise we kind of presume what the root causes. Those are very good questions that will and I think Department of Health may well be able to help us either answer the question or to suggest data collection that would inform that good. Okay. So that brings us to subsection B, which is the purpose section and the purpose to eliminate disparities and health status based on race ethnicity disability and LGBTQ status by establishing better and more consistent collection and access to data, enhancing an equitable range of available and accessible culturally appropriate health care and public services across Vermont, ensuring early and equitable inclusion of reminders to experience health inequities because of race ethnicity disability and LGBTQ status and eliminates to efforts and efforts to eliminate such inequities. And lastly addressing social determinants of health particularly social, economic and environmental factors that influence health. And social determinants doesn't actually include economic or environmental so you know it's very well defined so we're that that's when I do want to make sure that we're clear on it because we don't want confusion about what about meaning there. Okay. And then the next section. We're creating a new chapter on health equity. And in this chapter, there's a definition section and then it's creating the commission that representative liberate was referring to. So the commission itself plays kind of a short term role in providing recommendations to set up the office of health equity. It's an ongoing commission that has duties that extend far beyond the short term goal of kind of giving guidance on the setup of the office. So the first section is the definition section. I won't spend too much time on the definitions at this point and we can maybe go back and look at them in a bit more depth. I did want to draw your attention to the fact that there's a social determinants of health definition. And it seems that that's a place that you're interested in so we might want to spend some time looking at that when we come back to the language. Okay, so the next section is the creation of the advisory committee. And in our first paragraph paragraph we can have the mission statement of this group it's to promote health equity and eradicate health disparities among Vermonters, including particularly those that are black indigenous and persons of color individuals who are LGBTQ and individuals with disabilities. And the commission shall amplify the voices of impacted communities, regarding decisions made by the state, the impact health equity, whether in the provision of health care services, or as a result of social determinants And the advisory council is also to provide strategic guidance on the development of the office of health equity, including recommendations on the structure responsibilities and jurisdiction of such an office. So that's kind of the, as I said the mission statement of what this group is going to do and it's long term and short term focus. And then we have the members of the advisory commission. It's a long list. And I know you have other witnesses so for today, maybe I'll just say that there are representatives from the state and there is also an effort made and the health care committee to include representation from members of all the impacted communities on this list so for today I'll scroll past the list. Okay, and subdivision question just quick question and something we may want to raise with Susanna when we get there. And that is we do have a chief prevention officer in the agency of administration. So it may be that that person would offer some benefit to the commission and or the prevention director or manager that we have in DOH so just a, just a question. Okay, and I just wanted to flag for you that the last subdivision in this list of members includes any other members at large that the commission deems necessary to appoint to carry out the functions of this section, including ensuring equitable representation and balance between impacted communities and the health care provider perspective that health care provider perspectives are represented based on a majority vote of the members. Then in subdivision to we have the term of the office appointed shall be three years with the exception that members at large shall have a term of one year. And of the members first appointed who are not designated as at large members for or to be appointed for a one year term for appointed for two year term and 10 appointed for a three year term so this is kind of not all membership would turn over at the same time there's a rolling membership. Members would hold office. Yes. Sorry to interrupt. I, it's this is a huge commission. Are there. Is there a. Sorry, a chair it or how did they choose a chair to run the meetings or whatever. The bill that passed out of health care did have. Susana actually as the chair, the director, executive director of racial equity and then there's amendment on the floor to allow the advisory commission itself to select a chair from among its membership. So that that is a piece that has had some conversation and some change, since it left the health care committee, and we'll get to that language where. Oh, it's not we haven't gotten to yet. Okay. And is there any type of sort of executive committee or smaller subgroup. That has sort of separate subgroup of power sometimes with these huge commissions there's often a set of. There's need quickly or something does that in order to. I'm not suggesting we should do that. I'm just wondering if that was any ever just justice. There was certainly a conversation about empowering the commission to organize itself how it would. That it would be best suited to kind of determine the right structure for itself. Honestly, off the top of my head I can't remember if there is language about creating subgroups. And I'm sort of well we'll see when we get there I don't remember that there's a big language on subgroups but my recollection is that there was a lot of conversation about empowering this group to find the right way to organize itself. Yeah, I think I think the commission does takes care of the. And in the absence of language on a subgroup. That doesn't, of course, preclude any subgroups it's just not directive. Yeah, I'm just thinking committees and that kind of thing if that's necessary to have in or if that's just a given that these groups can make committees or executive committee or whatever. Right. So I'm so Katie, before we go further, I think, Susanna Davis has under pressure with her schedule so let's interrupt at this point. We'll put a hold on the rest of the bill and we'll have Susanna provide her testimony. Thank you for letting me know. Yes, and thank you all for your flexibility I apologize for interrupting the walkthrough for the record. Okay, for the records was on a Davis racial equity directed for the state. And I don't have prepared remarks today I just thought I would come in and answer any questions you might have and speak a little bit about the, the purpose and the intended benefit of the creation of this office and the setup of the commission. I did want to follow up on a couple of the questions you all have already asked. So I'll just take them in the order in which I recorded them. First, Madam chair you note in finding section number four, the social determinants of health. And I think also points number six and eight if I recall, and just making sure that we've clearly defined that and that we're accurately reflecting the social determinants of health. I just want to confirm that from my perspective and from my work in the Department of Health and Mental Hygiene in New York, that we do include all of those factors in social determinants of health and I think the CDC also has things like environmental and economic factors listed as well. So I would agree with the way that the bill findings lay out social determinants of health for what that's worth. The next one. The senator asked if health disparity was more a function of race or of poverty and whether we'd be tracking socioeconomics of people who are not people of color or just people of color. And personally, I would say let's track everything we can. You got data I want it. And so the, I think it's important to track socioeconomic status for all people so that we can really get deep insight into the effects of poverty or wealth into people's health outcomes. And, just as an answer to that first question, disparity, we often see is more a function of race than it is of poverty in the United States, not just in health but in other factors, because often when we control for socioeconomics, we still see deep steep disparities I'll give you one example related to income earning potential we see of course disparities in lifetime earnings and income for, let's say black Americans and white Americans. And that tends to be across the board, but when we control for socioeconomics like if we have white children who grow up in the so called 1%, the 1% top earners in the United States, compared to black children who grow up in the top 1% of earners in the United States, we still see that over time they both will grow up to have a 12 point difference a 12% difference in lifetime earnings where the white child who grew up in the 1% is still earning more than the black child to grip and 1% and of course that's with economics. But the same ends up being true about health disparities. So it ends up being more race is a better predictor of life outcomes than poverty is, but I still strongly think that we should be tracking poverty metrics or wealth metrics for all groups. The question was raised whether the chief prevention officer or the DOH prevention manager should or could have a role in this work. And without coming out and volunteering other people for more work, I would say there's absolutely a place for that in this and to the extent that those people and offices have the capacity, they would be very, very welcome additions to this work. And then commission chair selected by the body. Yes, and I think that that's one of the ways in which we are really accomplishing process equity by doing a little bit less dictating in the statute how a group shall work with one another, but rather allowing that group to determine the path forward for itself to make sure that it works in a manner that suits it so that amendment is is one that I agree with. I'm going to end up with those questions. I don't know if you had any others I can address. But I guess I just wanted to say generally about this bill that I strongly support the creation of an office of health equity. I along with the advocates remain disappointed that that is not a more immediate part of the bill that is to say that we've deferred the setup of the office of health equity for after the creation of the commission, although I understand the reason for it. It's about capacity and bandwidth. On the part of VDH given the current activities they're focused on. And I mean, I know you all have heard me say this in different hearings and in different contexts but I people of color have been asked for so many years to wait for justice for centuries really. While I recognize this the incredible urgency with which we must act on these and other factors. I also believe that I'd rather take a little more time and get it right rather than get it done now. And so, if we're not confident that we can set something up in a way that we're most proud of and in a way that's going to be most efficacious, then let's take our time and do it right and so So for what that's worth. I think that going about it in this way allows us not only to begin doing some of the work that is the setup of the commission, but also if you look at the list of members of that commission and the partners with whom they're supposed to be working. It really presents us an opportunity actually doing it this way, instead of doing them both simultaneously for those members of the commission and external partners to inform the setup and operation of the office of health equity. So I think that presents us an opportunity to make sure that the office is being set up not just based on what the state thinks is appropriate but really incorporating the feedback of commission members and members of the public and I think in the long run we talk about things like process equity and community sourced governance that that might end up working very much in our favor so I'll pause there and invite any feedback questions that you may have. So as you're as you're talking through this issue and the and looking at the commission and then the fact that the commission can add folks and we'll have a have a long arm to reach out to educational institutions. To medical facilities and folks and then might be recommending making recommendations regarding how medical students are taught how social workers are taught I mean you this could end up being a huge work period it's a it's a lot of work I can see that in addition to work which there's the whole area of the judiciary which I know you're anxious to get to but the are the are the parameters designed in the in the bill the charge or the mission for the commission. A are they too broad are they not broad enough one and how specific. This is hard I mean just how specific should they be our are we asking for this commission to do a total and complete and thorough analysis of all the cultural defects and I mean they are defects and gaps and places for improvement is is that what we're asking of this commission this is a huge task. I think that we're not necessarily asking the commission to do all of that work and all of that analysis but to play an advisory role in the office doing that analysis. And we we know that the health department has already been doing health equity work for years so they're they're they're well versed in it. I think it's just about having a robust and intentional structure dedicated to that. So the commission I think certainly would have a hand in identifying those shortcomings or as you say the defect. But I think it's really about more the serving as an ancillary supportive role doing things like grant making so having that I on the outside and the external partners who could be of service and being able to help guide the trajectory or at least help identify how we should focus it. It is a lot and one of the things that I that I'm grateful to chair liquid for being receptive to was my caution that, while I recognize that we do a lot of our work based on timelines that we allow for the flexibility here to make sure that if we do a lot of our work based on timelines that we can. Again oftentimes, you know rushed policy is rarely good policy. And so, so I think that the bill lays it out in a way that is fine. And if we determine that it's not quite fine in terms of timing that we that we have procedural grace. I'm sure that we empower the commission and eventually the office to have what it needs to get this right. I hope that's clear and then I didn't. Well, I think it will probably be made clear as we go through the bill because we haven't looked at the kind of the forgiveness policy for timing yet but appreciate that thought and and I do think that I understand what you're saying about social determinants but we may come back to that simply because this committee has had experience in putting in place policies related to social determinants we want to make sure that we're we have consistency across our our statutes so that that's why I raise that as an issue. Senator Hardy. Thank you madam chair and thank you, Susanna for being here today and your testimony. I was scrolling through the rest of the bill just to see if I understood the duties of the commission are, and it sounds like a lot of the duties are to come up with what the duties of this new office should be is that, and then there are some ongoing duties of the commission after the office is set up. And then your office has a large role in the whole thing and we haven't gotten to the fiscal note yet but I was just scrolling through that is there. It looks like you're tasked with making a budget request for next year for what you might need, but are there resources provided to your office. In the FY 22 budget in this bill or are they in a set, are they in the big bill or how was your office being resourced to do this work. Yes. So, so the proposal is put forward with the expectation that the separate funding proposal for two staff positions for the Office of Racial Equity be put in place. So absent that it's, it's, it's not clear that this could happen at least not in the timeframe that we've that we've carved out so one would be those two staff positions coming to or creating an Office of Racial Equity, and then there's a what I believe $180,000 note in there that would be for contracting with a third party contractor who can serve as a consultant and helping us to get up the commission and therefore get that ball of ruling. At some point after that I get to step away once VDH comes in. So my, my involvement really is, is more transitional than anything. Yes. Okay. And just in general, I mean, just a first read through the bill, it reminds me a lot of a bill that we, we passed two years ago act, what came Act one that's a similar kind of charge and group, working on this similar issue in our educational system. And I think one thing that I'm happy to see in this bill is that in these two years we have much more of a structure to do this work because of your office. And there seems to be much more of a, you know, an infrastructure that will help this move forward in a way that we kind of struggled with with that Act one two years ago so so I guess acknowledgement of and appreciation for all the work you've done over the past two years that we can get a little further along. And glad to see that we're doing this similar work in education and health and you know next the judiciary perhaps there's just so many places to tackle but and I guess my final question for you is, is there anything that you want to flag for us that you want us to look into that either the house didn't get to or that we should, or maybe didn't do in the way you would want them to, or, you know, something that we should change or people that didn't get heard from in the house that we should hear from. No, actually, I don't I'm grateful to the house for being for making changes and updates that are reflective of the guidance that they heard from directly impacted communities and from me as well. I just suppose that I would reiterate reiterate to you all that for this to be as successful as it can be. It's really going to be important that we trust communities enough to hand the reins over to them in making a lot of the determination so I think a lot of the sort of nuts and bolts questions that may be unanswered in the bill are really ripe for allowing members of the community members of the Commission to set those parameters. I know it's it's difficult because we are people who love and make rules. I think self determination is a really big part of this, particularly in Vermont we have an indigenous community that had largely had self determination taken away from them we saw yesterday the historic vote for the eugenics apology and and so much of our health outcomes for people especially indigenous community have had to do with not being able to make certain decisions for yourself so I would just reiterate the importance of that and because you mentioned Act one I cannot help myself I just I have to plug the importance of us resourcing the act one group. I sit on the committee I see how hard people are working and how important it is, and it's, it's, it was a wonderful and important piece of legislation. The work is happening, but it needs to be refueled in order to keep happening. So, I'm putting in an act one plug here. If you don't mind. Communicating that in an email to Nellie and copy me please. I think and copy the chair of education I think that was a bill that went through the Education Committee and I completely agree and that's what I was sort of referencing the sort of infrastructure of that versus infrastructure of this. So, good, good, good. And Senator. Thank you. Any other questions for Susanna. I think Susanna will be helpful to have you return as we go through the bill. If you have some time to do that. But you're obviously very a strong leader in this. And we need to have that input from you so thank you. Very happy to return thank you for your flexibility and thank you for your time. All right, terrific. Good luck in the judiciary committee. Thank you. Take care. Okay, so we'll, we'll just we'll finish up going through the bill for the next five or six minutes. And then we're going to jump over to another topic. Katie has a hard stop. So let's do that. Okay. Maybe I'll just skip ahead to the powers and duties of the commission. Yes. Okay. So first, the advisory commission shall provide guidance on the development of the office, which is to be established based on the commission's recommendations as soon as it's fiscally practicable to do so. And the specific and guidance will include the structure responsibilities and jurisdiction of the office. And the process of the office is to be independent and if not, in which state agency or department it should be situated how the office is to be staffed. The population served and specific issues addressed by the office. The duties of the office including how grant funds shall be managed and distributed, and the timeframe and necessary steps to establish the office. The commission should include providing advice and making recommendations to the office once it has been established, including input on rules and policies proposed by the office. Awarding of grants and the development of programs and services, the needs priorities programs and policies relating to the health of the impacted communities, and any other issue that the office of equity health equity requests, the advisory commission on also the advisory commission is responsible for reviewing monitoring and advising all state agencies regarding the impact of current and emerging state policies procedures practices laws and rules on the impacted communities, identifying and examining the limitations and problems associated with existing laws, rules, programs and services related to the health status of the impacted populations. And advising the health department on any funding decisions related to eliminating health disparities and promoting health equity, including distribution of federal monies related to coven. The extent funds are available for the purpose of distributing grants that stimulate the development of community based and neighborhood based projects that will improve health outcomes for impacted populations. And lastly, advising the General Assembly on efforts to improve cultural competency and anti racism in the healthcare system through training and continuing education requirements. We'll come back to that piece because there's kind of a short term report back on this piece. Senator lions. Yes. Yeah, what I didn't hear in there is how the office is going to be paid for. I may have missed it. But we just talked about how we're underfunding all of these things and now we're starting a new program. And I didn't hear anything about how the, how this new department would be paid for. Well, that's something we can ask and we can add that. I mean, I think, yeah, it's a, it's an important point. You can't have an office without some resources. Right. All right. In the interest of time, I'll kind of move over some of the more technical aspects of creating the commission. There is a section on data responsiveness to health equity inquiries. I'll just flag that as something that we should come back to the section for amends the existing duties of the executive director and racial equity to include the new duty of temporarily overseeing the establishment of this advisory commission until the office is up and running. And then in section five, there's a short report in the short term from the commission. It's to come back October 1 2022. And it's to consult with various licensing boards and professional organizations. And it's regarding recommendations for improving cultural competency and anti racism in Vermont's healthcare system through initial training continuing education requirements and investments. And that ties in with the last duty on the commission's list of duties. And then as I believe center lines mentioned, there is language in the report about asking the commission to make a budget recommendation to fund its work in fiscal fiscal year 2023, if necessary, to continue its work. Okay. Sometimes, you know, the work just extends to the time allowed, but so that'll be a, but we also want to be well done. But I also have a I have another question. Yeah, so Katie, I haven't memorized the bill yet but and I may not do that but the the issue of this is actually about health, right. So anything in here, there is in here about determinants of health social determinants of health. Is there anything in here about collecting data that identify the causes and influences for health disparities among these different groups. We'll have to open question, we can look at. Okay, there's a whole section on data that I went over very quickly just because I am scheduled to be in another committee at this time. So this section subsection a each state agency department board or commission that collects health related individual data is to include in its data collection health equity data disaggregated by race, ethnicity gender identity age primary language socio economic status disability and sexual orientation data related to race and ethnicity is to use separate collection categories and tabulations disaggregated beyond white and non weight in accordance with the recommendations made by the executive director of racial equity. And then there's language that the Department of Health is to systematically analyze this data. Using the smallest appropriate unit of analysis feasible to detect racial and ethnic disparities, as well as disparities along the lines of the categories that we just went through and to report on the results of this analysis on its website periodically but not less than by annually, and the department's analysis is to be used to measure over time the impact of actions taken to reduce health disparities. I don't want to keep you I'm also I've also been thinking about how we'll have to go through the bill again but just just how this commission interacts with, for example, the Prevention Council I mentioned the chief prevention officer but there is the whole Prevention Council and maybe, maybe there's some something to be gained by changing the constituency of the Prevention Council not not right away but going forward so just, just, I'll have to remember that. All right, and so just one last comment this did not go to house human services. I don't believe so no, I didn't go walk through with them. Okay, go to appropriations. Yes. They have $180,000. I think is what representative, the bird said in the budget set right and that's to do. That's probably one time money. It is. It sounds like. Okay, but somewhere we're going to have to talk about how we pay for an ongoing department. Yes. And that and they. So I think the original bill established CMEs for physicians and others to train for cultural competence competency. So I think that's a that's a goal here is to have some training for health care providers to ensure that they understand differences. I'm, I know that that's a goal for some of the folks. Okay, I'm trying to figure out if we have already determined what the outcome is going to be. If we're provide if we've already talking about providing training before we've done that. That's the problem. I mean, I. Yeah, I think these are these are really important questions for us to ask. And because you're what you're saying we don't want to. That's really not good science that's biased discrimination. If we've already determined what the answers are, then why bother doing the study. If we're doing the study to find out the answers, why are we putting in a solution before we've defined the problem. Well, and I want to move us off the conversation. However, I remember a research project that I started years ago on discriminatory practices in the sciences. It was on gender based discrimination. And I started out thinking I know what I'm going to find right. And I went through a long period of data collection and qualitative and quantitative data collection and low and behold, wow was I surprised it was completely different from what I had anticipated so we would hope that that sort of disinterested objectivity might prevail with a group like this we don't know so we'll find out. All right. Senator Hardy last question. It's it's mostly just a comment that I don't think I think we already know that there are that that there are disparities that are at the result of racism and discrimination and homophobia, etc. And that is clear the data is absolutely clear and that's what the first 11 pages of the bill is this study is is more about how do we what in our structure of the provision of health care in Vermont and the oversight of health care in Vermont needs to change as because of the data that already shows that these disparities exist, and then creating an office that will help improve and do away with those disparities that can be distinctly an office about, you know, so helping to solve the problem. So, I don't see it as a study of trying to figure out, do these health care disparities exist, we already know they do. There's no question that they exist. And, and so it's it's moving beyond that question as a way of how do we change our structures to to Yes, you're absolutely right. I think what Senator Cummings comment was. If, if we know that there are disparities and people are walking into it with ready made solutions or they are they are automatically know what the solution should be then what I do it so our goal is to try and sort out that we're going to see that this group is going to evaluate what the issues are and maybe not come up with the Pat solution there might be something completely unexpected that's all. Huh. Okay, so very good comment. Good, good, good discussion, we're going to get back to this. I have another time, unless I hear differently from the committee will keep working on this bill as well. And we'll have to will it'll it'll also be something that appropriations will be working on because there is an appropriation with it. I have with us. Part two of options for regulating provider reimbursement and so Robin, thank you for being here committee are you interested in a one minute stretch. Yes. I think it would be helpful for come back a two minute stretch. So at 1110 with great apologies to Robin and Elena and Sarah that will just take a very quick two minutes. Thank you.