 Okay, let's go for it. I want to say thank you all for being here. This is a joint meeting between house health care, led by representative Lippert, health and welfare led by myself, Senator Lyons, and our committee members are all present today. We're taking up an issue. I think of interest to both committees on diversity within the COVID-19 response and trying to understand what's going on in Vermont, the data that we're collecting and so on. Before I begin, I'm going to ask Senator Ingram just to say a couple of words. This was an issue that she has been very interested in having our committee work on. I know representative Lippert, I want you to go first and then Senator Ingram, because I know it's an issue of interest to both of our committees. So, Bill, why don't you start out and then we'll go to Debbie. Thank you, Senator Lyons. Yes. Our committee has expressed interest in this, in the issues of diversity and equity within the COVID-19 response, particularly around issues of race, but also access for persons with disabilities. And I believe today will primarily perhaps not exclusively, but primarily focus around issues of race and the importance of understanding the disproportionate impact that's happening across the country and what we in Vermont need to do in order to both understand and address issues here in the state as well. So I'm looking forward to hearing from our witnesses. I understand we have a representative from the Department of Health who will be listening and responding. Hopefully we'll hear what their response has been. And there's certainly been some issues in the media. But with that, I'd be happy to turn it over to Senator Ingram. Thank you. Yes, I really appreciate the both committees taking an interest. And we've seen in the news that in other parts of the country, they have data to demonstrate that the number of people of color, especially black people who are affected by COVID-19 is as much as double their representation in the general population. And whenever we have that kind of inequity in other parts of the country, I think Vermont needs to be aware that we are not immune to such inequities. Sometimes our challenge is not always having the data that we need, but we should be, I think, very intentional about getting that data and be very sensitive to the inequities that exist. And so I'm very glad that we're examining this issue and hope that we can come up with some solutions going forward. Okay. Thank you. Thank you both. I think everyone on both of our committees could give a speech or provide information about our interest in this area. So I think that before we, before we go ahead, I would like to ask Nellie, are you there? The question I have for you, are there other folks interested in testifying who are not on our agenda? I haven't had anyone else email me. No. I know that we had suggested. I guess Amanda is here from. Yes. Yeah. Okay. Good. We're all set then. Yeah. I just have to find my agenda. Apologize briefly. Want to make sure we go in order. So Susanna Davis, thank you for being here. Welcome. I don't know that you have been in. Senate health and welfare previously. Have you? No, not yet. Okay. And. And I don't have you been before house health care. Not yet. No, not yet. Well, so welcome to you. Welcome to both our committees and rather than go around the entire screen and introduce ourselves. We'll do that as we might ask questions. So. We're very happy to hear your testimony. On equity issues, diversity issues related to COVID-19. So why don't you introduce yourself for the record. And we will listen to your testimony. Thank you. Thank you, Madam chair for the records to sound a Davis racial equity director, state of Vermont agency of administration. All right. So today my testimony will be a bit longer than it tends to be when I visit the legislature, evidently, there's a whole lot to say on this topic. And I do invite my friends from the health department to chime in. If they notice me making a factually incorrect statement, this is something that we want to get right. And of course I invite any of you, senators and representatives to interrupt me as needed with questions, comments and consent correction. First, I will tell you a little bit about my role and my stake in this, then I'll talk about some national trends that we're seeing. I'll follow up with a little bit about Vermont specific information. And then I will end speaking about upstream factors, social determinants of health that contribute to these issues. And I will leave you with a couple of key parting thoughts. So, as you know, I am your racial equity director. And the enabling statute that created my role that was act nine of 2018 requires me to do well a number of things, but two of them are one identifying systemic racism in Vermont state government and two overseeing the statewide collection of race data. Needless to say, this topic falls squarely within that mandate. And I want to give a note on structural racism. I haven't done my spiel yet to either of your committees. So you haven't heard me say this in this context, but I want to make a note about structural racism when we talk about identifying structural racism in state government, structural racism doesn't mean intentional racism. It doesn't assume ill will it refers to systems that create racially disparate outcomes. And this is important because a lot of times when we talk about racial equity or systemic racism, it triggers a defensiveness in folks and they take it as an accusation and end up ignoring the underlying substantive issue. So when we talk about systemic racism that doesn't assume ill will and I want folks to be part of this discussion to be present in this discussion from a place of solutions, not a place of accusation. Before this job, I was at the New York City Department of Health and Mental Hygiene. I think my world would look a lot different right now if I were still there. While I was at the health department, our major focus was health in all policies and health equity in all policies. So a lot of my previous work was in the health sphere and it centered around understanding the relationship between upstream factors and health outcomes, which I'll cover later. So I'd like to move into discussing some of the national trends that we're seeing. I won't go into specific population numbers because I think some of your other witnesses will cover those, but the general trend is that areas that are reporting race data related to COVID-19 are showing that people of color, specifically African-Americans, are disproportionately represented in COVID-19 cases. In addition to African-Americans, tribal nations are also suffering disproportionately through COVID-19. Some examples of that include the strain on the sovereign to sovereign relationship that has been caused by certain state level restrictions. The multi-generational housing that's very common in a lot of our Indigenous households around the country has created challenges with social distancing. I'll talk a little bit more about that later. Economic impact, for example, a lot of our Indigenous folks in the United States have relied heavily on the tourism industry, particularly around casinos. That has suffered tremendously, and that represents a huge economic foundation for that community. And lastly, things like clean water for hand washing are not always present in some tribal lands. And I'll get to that again a little bit later also. I'd like to talk about also why this information is important. When we talk about reporting race data related to COVID-19, it's often seen as an afterthought or a subset of data. Truth be told, the data are critical information, are not necessary for us to have real-time analysis, not just sort of be pieced together after the fact, because it allows us to do more than just analyze a loss of life after the fact. It actually allows us to mitigate harm to avoid the loss of life on the front end. And we've seen this before, right, and related to COVID-19. For example, at the outset of the pandemic, it was believed that COVID-19 was less fatal for younger populations. And a lot of younger adults around the world took that as licensed to continue congregating and to neglect detailed hygiene practices. But it was the real-time tracking of young people contracting and dying from COVID-19 that prompted a global shift in attitudes of young people who then began taking this more seriously. That saved a lot of lives. And it was a no-brainer. It's a no-brainer that we would want to do this for all populations. Now, Vermont is a special and unique and wonderful place, but it is still in America. And as Senator Ingram stated earlier, Vermont is not immune, pardon the pun, to the issues that Americans confront. So let's talk a little bit about Vermont data. And I'm going to tease this a little bit by stopping first. I want to tell you first about the mechanics of the way that we're collecting these data. Before I give you the actual numbers. So how and when are these data collected? They're collected at the point... And when I say these data, I'm talking about race and ethnicity data related to COVID-19 cases. These data are collected at the point of patient contact. So they're primarily collected by the providers. Another opportunity that we have to collect race and ethnicity data is when the Department of Health's EPI team, the contact tracing team, follows up with COVID positive patients. So a patient interacts with a provider. They get a test. If the patient tests positive, there is follow up from the state. And so those are two opportunities that we have to collect race data. Now, on the collection rates, the form that's used at the point of COVID-19 screening is a form that's created by the CDC. And it contains a section that asks about ethnicity and it contains a section that asks about race. Until recently, providers in Vermont were only filling in that information 27% of the time. So three quarters were not completing race and ethnic data. This means that the data that I'm about to share with you are massive underestimations. And actually, I need to repeat that because I don't want you or anyone else who's listening to latch onto these numbers and draw conclusions from them. The data on race and ethnicity for Vermont's COVID-19 cases is distorted due to underreporting. Now, what are we doing about that? Because of this, the VDH, the Vermont Department of Health, has issued guidance to providers and to the contact tracing team to ensure that this information is being collected going forward. So our data will improve in the current, in the coming weeks related to race and ethnicity, but it will remain incomplete until we revisit the previous missing data and fill it in. And that step is key. Filling in the missing data from before is just as important as collecting the data from this point forward because the data we're collecting now appear to reflect a downward trend of cases overall in Vermont. But some of the most critical data are those from the initial outbreak, which are really invaluable when we talk about vulnerability and preparation for future statewide emergencies. So I don't want anyone to think that filling in previous data that we didn't have isn't as important as collecting data going forward. I would say it's equally as important, and that's a step that I'll talk a little bit about later. So, per the information that I have, I'm going to give you racial distribution and ethnic distribution for COVID-19 cases in Vermont. I want to note for you that we don't have race information. I'll start with race. We don't have race information for 59% of these cases. Now, I know a few minutes ago, a few moments ago, I just said that we were collecting at a rate of 27%, which means 73% was missing. And now I'm telling you 59% is missing. That's because since we've issued that guidance to providers and to the contact tracing team, that data has been coming in. And so now the missing data represents a smaller share of the overall data. Does that make sense to everyone? I'll just take nods. Okay. So, we have I bought No, no, that's right. Okay. So we don't have race data for 59% of cases. Here's the data we have for cases reported through April 13th, which was Monday. We had 310 cases of COVID-19 in Vermont that did report race and 440 that did not. Of those that did report race, which again is 41%, of those that did report race, here are the counts. American Indian or Alaska Native, there was one case. Asian, there were five cases. Black or African American, there were five cases. White, there were 299 cases. Here are the percentages into which those translate. That one case for American Indian or Alaska Native translates to 0.3%. That those five cases of Asian Vermonters or Asian people in Vermont translates to 1.6% of the total who reported race. The five cases among Black or African Americans translates to 1.6% as well. And the 299 cases of white folks who tested positive for Vermont whose files included race data account for 96.5% of those cases. Let's move on to ethnicity. For ethnicity, we do not have ethnicity information for 62% of those cases. Here is what we have. 285 cases contained ethnicity data. 465 did not. Of those that did, those who were listed as Hispanic accounted for four cases or 1.4%. Those who identify who are identified as non-Hispanic accounted for 281 cases which is 98.6%. I do want to remind the members of the committee and members of the public that race and ethnicity can and often do overlap. So the four Hispanic cases or the 281 non-Hispanic cases are not mutually exclusive of the race categories of Black, Asian, White or American Indian, Alaska Native. I'll stop there because I know that was a lot of numbers. I will stop to see if anyone has questions. I do have a question. So the data that you're talking about, can we find this on the Department of Health website or some other location where it's consolidated? Yes. I am not 100% sure. I should have checked before this hearing. I apologize. If it is not already on the portal, it will soon be on the portal. And if you don't mind, Madam Chair, I can get to that in a little bit more detail in a moment. Okay. I see that there's a friend, David Englander of the Department of Health who is willing to reach out. Would it be all right with you if we call on David at this point? Oh, please. Good. Okay. Welcome, David. Good morning, Madam Chair. My name is David Englander. I'm the Senior Policy and Legal Advisor of the Commissioner of Health. I'm grateful to be before the committee and we'll talk a little bit later. Thank you. Thank you. Thank you. Thank you. This is summary data. I've now sent to Nellie. It is now posted on your website. That's a daily update. That we the Department of Health is now including all this information on a daily basis. It will also be by the end of the week on our, we have a dashboard publicly available dashboard and that by Friday will be available. To the public and updated every day. Okay. Thank you. Terrific. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you for all of our web pages. Thank you. And Nellie hasn't good enough to post it already. Good. All right. Other. It's nice to have a friend. Oh, I appreciate the assist. Yes. Are there questions from. The committees. I see Senator Ingram. I see representative Smith. Senator. And then we'll go to Brian Smith. Thank you. So I'm Susanne, you mentioned that. Going back sort of going back in time to get collect the race data. From earlier when, you know, it was not. Being collected would be important that 73% of time. Times wasn't collected is how is that possible? How can we do that? Based on my conversations with health department leadership, it is it is an undertaking, but it is largely possible. So some background on that is that and this will go into some of the caveats that I'm going to issue momentarily, but so a lot of times the information is perceived, not self reported. So if at the point of patient contact, the provider has not included this information, one step that we could take is to find out if it's already included in the patient's medical file. If that information does appear elsewhere in the patient's medical record, then that could help us to fill it in. However, if it's not, then again, another opportunity that we might have is if our epi team or contact tracing team initiates or maintains contact with the patient and can fill that information in at a later date. One of the challenges with that is capacity, of course, right? I mean, the health department, the epi team are doing monumentally much more work than I think any of us could have anticipated. They would end up having to do this spring this winter. So being able to do that is, it's time consuming. I don't pretend that it isn't, but it is possible, I think. We just have to be diligent, I think, and be insistent with our providers on making sure that everybody understands the importance of gathering that information. Thank you. Okay. Representative Smith. Thank you. Good morning, Director. The percentages that you just explained a moment ago, aren't they the same percentages of what the population of Vermont is? Thank you for pointing that out, Representative. So right now, the numbers appear to track closely with Vermont's racial and ethnic demographic population. However, and this is a big however, we are, this is with the understanding that our data are limited. We're only talking about 59 or rather 41% and 30 something percent respectively for race and ethnicity. So if the full numbers keep pace with the numbers we do have, then yes, it would appear that we are equitably distributed just in terms of our statewide population numbers. And that would indicate no disparity or at least not the same kind of disparity that we're seeing in other parts of the country. If the full also, I'm just going to repeat that. If we had all the race data for all the cases and they kept pace with the numbers we have seen so far, it would track closely with population numbers and that would be within an acceptable margin of who we would expect to see in our case. However, because of the limitations of our data, we only have a portion of it. Thank you very much. I think that's what makes Vermont such a great state. Thank you. Representative Derpy and then Representative Lippert. Yes, thank you. Good morning, Susanna. Just following up on the Representative Smith's question, I'm wondering, do we know, do you know anything about when data is underreported this way, whether we can say anything statistically about the likelihood of the pattern continuing to hold or not? Does that make, may I ask me that in a way that makes sense? I think I understand the question and I appreciate it because this gets at one of, this gets at one of the challenges that came up in my discussions with VDH leadership. You know, I'm not a data scientist. I actually, I didn't wear shoes today to make sure that if I had to count above 10, I could use my fingers and toes. That's a joke. I'm wearing shoes. But I'm not a data scientist. I'm not a numbers person, which is why I rely very heavily on those who are people who work in health departments, people who are in the sciences and in healthcare. We have to trust when they report data to us that they understand the mechanics of those numbers. And so one of the things that I discussed with VDH leadership was the challenge of, or the question of whether it's possible to report incomplete data. You don't want the public who may not be as well versed in statistical analysis to draw conclusions from a limited data set. So if I think, if I'm understanding your question correctly, then what's really important, and I will get to this later, what's really important is not just that we have the data, but that we report it in a way that is responsible and that communicates to the public that it is limited, that we can't draw firm conclusions, but we can at least start tracking patterns, which is absolutely better than not seeing it at all out of fear of misinterpretation. In other words, I would rather see an incomplete data set with a lot of asterisks and caveats than not see a data set at all out of fear that folks might not understand it. I hope I've answered your question. Let me know if I haven't. Okay. Representative Durfiger, are you frozen? I think you are. We'll move on to Representative Lippert and then Representative Cordes. Thank you, Madam Chair. I do want to add, I'm only halfway through my testimony, so... That's okay. We can go to 12 o'clock. We do have several other folks in line, so we'll take two more questions, then we'll listen to the rest of your testimony and try to move on to the other folks who are here with us, so thank you. Let me underscore the importance of completing the data that has been talked about. I've had a great deal of experience in my previous roles, Chair of the Judiciary Committee, in trying to establish roadside stop race data, and having incomplete data completely distorts the situation, and until and unless we have complete data, we really do not know what we have in front of us. It does take work to go back and complete this data, but fortunately, this has been addressed at this point, and I think it's imperative that the data set be completed. Okay. Representative Cordes. Thank you, Chair, and thank you, Director Davis. And I have a feeling you're going to, Director Davis, you're going to get into this, but I just wanted to highlight what I think one of the most critical uses of accurate data, or one of the most destructive uses of inaccurate data, is that it impacts the resources provided to specific communities, and that is essential when we're talking about preventing the spread of contagious diseases like COVID-19, when we could be doing more to help communities that have congregate housing, like our migrant workers, and also impacts access to resources, again, access to housing, access to healthcare, and then once within the healthcare system, how implicit bias impacts how those people are treated. So again, I imagine you're going to get into that, but I just wanted to highlight that's why we want data. Thank you for that. And so Will, I think that underpins a lot of the concerns that are out there, and I will move back to Susanna and let you move on with your testimony. So I know you had mentioned something about social determinants, and I think that Representative Cordes was moving into that. Yes. Go ahead. Thank you. So I've just given you some numbers, and I need to give you some caveats to go with those numbers. First, the race inputs from the form are often perceived not self-reported, and I have to say just for good practice, I stress to you that whether we're talking about traffic stops, CDC screening forms, school enrollment, it is monumentally better to have people self-report their ethnicity or their race rather than to assume it on their behalf. For example, I would always be miscategorized because, you know, typically folks assume that I am Black American, and so it's really important to let people self-identify. Also, the mixed-race population in Vermont is projected to more than double by 2050, so it's going to get increasingly difficult to guess a person's ethnicity, and frankly it's a bit presumptuous to do so. So I always recommend, in all contexts, let people speak on their own behalf. So all of that is to say that the race and ethnicity data that we do have not only does it represent a small percentage of the total COVID-19 cases, but we're also assuming that people were accurate in their categorizations. Next, what we know only comes from what's reported, that is to say the numbers could be higher. We have people who have contracted and unfortunately died from COVID-19 who were in their homes, who were not tested, who were not tracked, who didn't die in hospitals. So the numbers could be a lot higher, especially when we talk about marginalized populations. Of course, the numbers could possibly also be lower. There have been some questions at the global level raised about the difference between dying of COVID-19 versus dying with COVID-19. However, one thing that I do want to highlight here is that what we think we know about race and ethnicity with COVID-19 cases, we know that because of the collection practices, it is an undercount, but because of the unknown unknowns, it could also be an additional undercount for that reason. Next, there's the question of the size of the datasets because of potentially identifiable information. As you know, HIPAA and other regulations govern health privacy, so there is a difference between what we want to share and what we legally can share. That said, it's critical that we do everything that we can to share as much as possible while remaining in compliance with applicable laws. And last, I just want to say that we're not drawing conclusions yet, and we're not assuming that there is a disparity. We're really talking about getting the data in the first place to see if disparities exist, right? So it's not that we're not looking for problems, we're looking to head off a problem before it turns into a more tragic problem. Now, I want to talk about the work we're doing in Vermont going forward. I am extremely pleased and grateful to the VDH for all of the expertise and the support that they've provided, helping walk me through numbers, and helping me understand the technical aspects of the COVID-19 response at the clinical level. Public posting, race data, as David just shared, will now appear on the VDH COVID-19 public dashboard, and it's going to be updated daily along with the other demographic information on that dashboard. And I have to say this, the responsibility for presenting those data doesn't just rest entirely with VDH. Our friends in journalism, our friends in data analysis, and other professions bear a great responsibility to report these data in a way that accurately reflects its limitations. For example, helping their audiences understand the impact that a 27 percent reporting rate can have on a dataset. It also requires that all of those other partners provide the appropriate context for the responsible interpretation of data to avoid misleading the public in a way that I'm about to discuss momentarily. So I want to zoom out a little bit. We've talked about some national trends and I'm confident that your other witnesses will get into more detail about what some of those other trends are. We've talked about the Vermont specific numbers and about what VDH and my office are doing jointly to ensure that these data are governed and protected better going forward. Now I want to zoom out a little bit and talk about the systemic factors that have helped get us to this point. You may hear quick takes about why people of color are more susceptible to COVID-19 and a lot of those quick takes are bad takes. As a general rule of thumb, please do not trust anyone who in the face of a systemic problem prioritizes an individual response and I'm going to deviate a little bit from my normally calm demeanor and get a bit adjunct. This is a plan to outburst if you will. Systemic problems require systemic solutions. I am not yelling at you. I am yelling through you. No amount of downstream shaming is going to mitigate the upstream factors that prime certain communities for harm. This concludes the planned outburst. Recently, the U.S. Surgeon General Jerome Adams made some comments at one of Washington's daily press briefings and those comments have done more harm than good. I would like to address those comments and help you understand the underlying factors that lead to the myths that, unfortunately, he has spread. He mentioned that he spoke to Hispanic leaders and African American leaders. I was curious not to have heard him mention Asian or indigenous partners in this discussion. As we know, nationally, there was a very sharp anti-Asian sentiment with the initial spread of this pandemic. This is something that we've seen even here in Vermont. I've spoken with our friends at the Vermont State Police who have informed me that there have been incidents of bias related to COVID-19 against members, Asian members of the Asian Vermonters. He also acknowledged that Hispanic people represent a majority of COVID-19 deaths. What he did not mention is that many Hispanic people may not even be presenting for testing or treatment due to the chilling effect that's caused by inconsistent messaging around immigration enforcement. Therefore, the numbers of Hispanic people could likely be very much higher. He also stated that it's, quote, alarming, but not surprising that people of color have a greater burden of chronic conditions. This is code for it's to be expected. And why exactly is it to be expected? African American and Native American people, he says, have more high blood pressure and get it at younger ages, and that Puerto Ricans have asthma at higher rates, and that black boys die of asthma at three times the rate that white boys do. He does not acknowledge that people of color are often priced or redlined out of more well-resourced neighborhoods that bear the lower brunt of ecological harm, that they're more likely to live in counties with higher rates of PPM 2.5, that's fine particulate matter, which contributes to higher asthma rates, or that neighborhoods that are majority people of color are more likely to have food deserts and food swamps. And I'm sorry, I'm going back to my health department days. I have to define for you a food swamp, which is an area where unhealthy food options vastly outnumber healthy food options. The metric they use is four to one. So food deserts and food swamps tend to be located in majority minority neighborhoods, which often has a direct correlation to higher rates of diabetes, heart disease, childhood obesity in these underserved neighborhoods. This is a result of strategic disinvestment, historical lending discrimination, and other factors that corral certain people into well-resourced areas and others into under-resourced areas. The Surgeon General also said that the chronic burden of medical ills and social ills make people of color less resilient to COVID-19. And what are the social ills that he mentions? He says that people of color are more likely to live in dense housing, which poses a challenge to social distancing. He fails to mention that this is often not by choice. Ask any recent college graduate if they want to have five roommates. He also says that teleworking is not common among the African-American and Latino communities. He fails to mention that employment discrimination, disparate educational opportunity, not to mention the exorbitant cost of higher ed, means that African-American and Latino people are less likely to get jobs that lend themselves to teleworking. He also says that many Navajo Nation members lack clean water for hand washing. He fails to mention that indigenous nations in our country have had to constantly fight to protect land rights and work against ecological harm that leads to unclean water supplies. He says to us, and this is a direct quote, you are not helpless. He tells us to adhere to task force guidelines and to avoid alcohol, tobacco, and drugs. He says, quote, we need you to step up. As far as I've seen, and I haven't seen, and I haven't seen the surgeon general who is, who identifies African-American, I haven't seen him give any health briefings related to COVID-19. So I won't publicly comment on why he was brought out to do this particular comment on people of color. But I will say that as far as I've seen, admonitions about alcohol and drug use have not been part of the public health guidance issued at the federal, state, or local broadcasts that I've been watching. It's curious why it's mentioned here. Additionally, it's really hard for some folks to feel comfortable following the task force guidelines, such as wearing a mask in public. When we see in certain jurisdictions, for example, Illinois, that there are reports of African-American people being followed and even removed from stores by police and told to remove their masks because it makes them look suspicious. And we've seen this before during emergencies in the United States. I draw your attention to Hurricane Katrina, where some folks of color in New Orleans were described as looters, while others were described as finding food and supplies. And oftentimes that hinged on what they looked like. I'd also like to discuss, and I should have mentioned this a few minutes ago, but the importance of language access and inclusive messaging in public health emergencies. And an example that I frequently use is the example of Flint, Michigan. When the residents of Flint, Michigan were alerted to the fact that their water had been poisoned, the Spanish speaking or rather the limited English proficient community in Flint was exposed to poisoned water for weeks longer than white residents simply because the city had not been doing enough outreach in Spanish. Something that basic contributed to monumentally bad health impacts for minority populations. So that our leaders would purport to write off the enhanced vulnerability of a quarter of the country as the product of our residential and employment and substance use patterns is a cop out. And Vermont is not a cop out state. If we were, we wouldn't be having this hearing. So it's not enough that we simply know within ourselves that people like this are in general and the interns who write his speeches are wrong on the facts. We must also actively counter these persistent and harmful myths. So please tell a friend. I will leave you now with just a few parting thoughts. I thank you for your indulgence as I've taken up nearly an hour of your time. One, assessing systemic inequity is a critical part of protecting the most vulnerable. This is not optional. Two, I've been having similar conversations around the COVID-19 response and its impacts on people of color in Vermont in other contexts in criminal justice and corrections and economic development around minority and women owned business enterprises and in other sectors. Across the board, I'm finding that data regarding people of color in Vermont as it relates to COVID-19 are not being brought to light widely and are not even being queried in some cases. So this is really a broader issue. This is highlighting bigger patterns of practice here. Next, if we acknowledge that there's urgency brought on by COVID-19 for dominant groups or for privileged folks, then there's an exponential urgency for people who are marginalized or underrepresented. And this includes people living with disabilities, the LGBTQIA plus community, people experiencing socioeconomic hardship and others. I want to remind you don't look away because the problem that we ignore becomes the problem that's much bigger to deal with later. And last, I want to remind us not to let small numbers dissuade investigation and not just in health, but in any context. Because concern for privacy or the bandwidth of staff, they end up rendering us invisible entirely. And I have to say this, I'm channeling our state librarian, Jason Brotton. This is especially important when we think about the 2020 census, which is right now delayed and really hampered by COVID-19. And the census is also, this is the first year that they're going to be using an anonymizing algorithm. I'll let you investigate that on your own time. But effectively, that algorithm threatens to erase small communities in rural states entirely. So that makes it especially important that we accurately collect our own data in contexts like these, because the ability to keep our own stats and cross check our data sets against a redesigned and interrupted census is going to be really key. That's all we're going to have for the next decade. And last, I want to think in terms of community empowerment, I want to think about, I want us to think not just about data collection and information collection, but also about information exchange. And VDH is on a wonderful job of keeping the public informed, not just during COVID, but in general. That's its general practice. And this is how we build community trust. It's not just about going to communities and saying, I need all your data, and then not coming back with anything. That's not how you build community trust. So I encourage all of us that when we think about this, think of it as a two-way street, think of it not only as collecting information for our own use, but also providing information. And again, I think VDH always in other contexts besides COVID-19 does a very good job of engaging community in that way. Thank you for your time. I'm happy to answer any other questions you may have. Susanna, thank you so much for your time. This has been extremely valuable for everyone. I think it's highly objective and useful, not just during COVID-19, but going forward. Thank you for that. I see that Ann Donahue had her hand up a long time ago. Ann, are you still Representative Donahue? Are you still with us? Not. Well, if she comes back, we might go back to you with a question. Any other quick questions? Because we do have other folks. We're good. I think this is the beginning of a longer conversation. Thank you for being with us. Senator McCormick had his hand up. Senator McCormick had his hand up. Good. Okay. Thank you. Go ahead. Thank you. Thank you. Susanna, thank you. That was a wonderful presentation. I appreciate it. How would we get the data that's lacking? Just having a race or ethnicity question on every intake, or what do you suggest we do to get better data? So with respect to COVID-19, the screening form that's being used is designed by the CDC, and it does already have an input field for ethnicity and an input field for race. I don't think that the trouble was whether there was space for it on the form. The trouble was that a lot of folks at the provider level, at the point of first patient contact, did not consider that to be part of the basic information that was necessary. And to some extent, you can understand they're all strapped, they're doing a million intakes, and they figure we're just going to do what is absolutely minimally necessary. And so what I'm here saying is that race and ethnicity is minimally necessary. And so VDH has issued guidance both to providers and to the members of their contact tracing team to that effect, telling them that race and ethnicity data is mandatory data that needs to be collected going forward. So it is our hope and our belief that the data will be more complete going forward. And then with respect to going back to recapture the missing data that we didn't previously get, I do think that that's a task that our FE team will likely have to undertake in partnership with the providers themselves. So I don't pretend that it's not going to be labor intensive or time intensive, but it's incredibly important for a lot of reasons. Thanks. That's all, Madam Chair. Thank you. All right. In the interest of time, I'm suggest that we move on. We have three additional folks to testify. And we have the Department of Health, David Englander here as backup. And we will try to get to you, David, as well at the end of the at the end of the other testimony. Let's see how we do. Tabitha Paul Moore is here from Rutland, President of the NAACP. So welcome. Why don't you introduce yourself for the committee and then we'll listen to your testimony. Okay. Welcome. Thank you so much for having me. I'm Susanna. That was phenomenal. And I was able to take out a lot of what I was going to say. So hopefully that'll save us on time. So I am the president of the Rutland Area branch of the NAACP. I'm here today speaking not only as president of the NAACP, but also as the Vermont director of the NAACP. And so what that means is that I'm testifying not just on behalf of Vermont's branches, but also on behalf of the New England Area Conference of the NAACP, which is the next level of administration for our organization. And for those who are not familiar with the NAACP, we are the nation's largest and oldest nonpartisan civil rights organization. And we have more than half a million members. So I'm representing a lot of folks coming here today. Nationally, we've issued guidance. The NAACP has issued guidance to states about racial and ethnic disparities, as well as some suggestions for ways to go about dealing with or addressing those. That guidance came out early in the beginning of the federal response to the pandemic. So I can provide that information for you in writing if you'd like that as well. On a state level, myself and my colleague Stefan Gillum, who's president of the Wyndham area or Wyndham County branch, sent letters to the Department of Health as well as to health care providers and to people of color regarding COVID-19 and how we could do better as a state related to data collection. That is encouraging people of color to come forward and request that it be documented until the Department of Health comes out with a guidance beyond that initial document. And that is a very difficult ask for us. I don't know if you're familiar with people of color in our history with the U.S. welfare health systems, but it's not great. So this is a huge ask to ask people to self-disclose racial and ethnic demographic information. But it is something that we're doing because we think that given that Vermont is so late to the game in terms of collecting this data, we need a multifaceted approach. So we sent it to the Department of Health. We sent one to people of color. And we also sent a letter directly to health care providers. And again, I'll send that to Nellie or I can try to put it in the chat so folks can see what and why we're doing that rather than explain it all here today. But I think I think I'll send it to Nellie and go up on our web pages. Great, I'll do that. But like I said, at this point, we see that it is critical that everybody is starting to ask or provide this information so that Vermont can get a better picture of what's happening now. Ms. Davis provided a very thorough review of the demographic breakdown of race and ethnic data nationally and statewide. And as she noted, the data is extremely limited and incomplete. And it's important to remember that we don't know who's reporting the information. She did mention that there's a huge difference between self-report and provider assumption. For example, in my own life, you might look at my son and see that he looks like your average white kid. What that means as far as his healthcare provision is that folks are not going to ask him questions, for example, related to sickle cell, which is a trait common in African American communities. So it's not only just not good form not to ask, it can actually have pretty devastating consequences when people do not ask us this information. And 27% we know that that's, you know, we don't want to do anything based on 27%. And so those of us that have been advocating for the release, the public release of the information, we are grateful for what has been able to be cobbled together at this point. But we also know that an incomplete data set can be dangerous in the wrong hands. And it's really difficult to, you know, pat ourselves on the back for the fact that right now it looks like it is going along Vermont's racial demographic breakout, the COVID-19 data collection. So we want to make sure that folks are extra cautious not to assume that that trend will continue as we get better with data collection. We know that the Department of Health is dedicated to patient-centered care. At this point, it's not a matter of whether they're going to collect the data. We know that the Department of Health sees this as important to do. So what I want to focus on is what we want to know. And so what we want to know is not just the state-level breakdown, but also the county-level breakdown. And the reason, and within that, we want to know who's getting tested, who's infected, who recovers, and who's dying. Because at every level of the system, at every point in the system, we need to understand where the disparities may or may not happen. And again, we're not saying that it's automatically happening that way in Vermont, but we're scared, just like everybody else. And we deserve to know. And in developing the response, the Department of Health can be more targeted in what they do by having that information. Likewise, for us, for people who are doing the work of racial justice, or just people of color in general, it's helpful for us to have this so that we can do targeted outreach. As Ms. Davis mentioned, the levels of infection in Hispanic communities tend to be even higher, Black and Hispanic communities. So if we're looking at it by county in Vermont, and we know that there's a high concentration of Hispanic folks in one area, but it looks like there's an underreporting based on trends and data, those of us who are racial justice advocates can then go out to those communities and find out, hey, what's going on in a way that the Department of Health cannot because of our relationships and the type of work that we do. So this data isn't just helpful for the Department of Health in the response, but creating a comprehensive community-wide response. Having this data will help us to do that. We are also noticing, Ms. Davis mentioned that the Vermont State Police is seeing an uptick in anti-Asian hate. We are seeing that here in Rutland County, as well as targeted hate toward Hispanic and African-American folks. It has gone up, I've probably fielded more complaints in the last month than I did January and February and March combined. So it is problematic. And we are hearing, and we have this horrible video where somebody targeted Hispanic folks with New York plates in Rutland County, they are spouting bad statistics. We don't want that to be a thing here. So again, that becomes really critical to the work that we're doing to keep Vermonters safe and healthy. A second thing that we want to see is healthcare provider reporting raw data and percentages. So what that means is we want to know which counties are doing a good job reporting race and ethnic data so that we can see where the problems are. Because maybe it's a matter of educating healthcare providers on how do you ask this question when it's something that in the 90s you didn't ask about race, that whole color blind thing was really popular. So it might be a matter of that. It might be a matter of some other issue within the healthcare system that needs to be examined. And we as folks in the community want to see that information too so that we can encourage our healthcare providers to comply with Department of Health protocols and procedures. I'm trying to go back and forth between looking at you and looking at my notes. You can look at your notes where you're fine with that. Fantastic. So like I said, and that came from my colleague Stefan in Wyndham, is that we need to know who isn't doing this so that we can touch base with them and ensure that they have the supports that they need. So it's not just DOH band-aided, but they understand that their community wants it as well. The other thing that we support is the creation of a demographic that got our responsiveness team within the Department of Health. We see that comprising obviously the statistics team, the epidemiology team. I think I got that right. Susana, the executive director of racial equity, and then community members, particularly advocates from different groups, not just racial demographic groups. We are concerned, particularly because no one has a single issue life. We have people who are disabled, brown and black communities. We have people who are queer. We want to know how this is playing out across demographics, and we want to understand then the issues that the Department of Health has in data release, and come up with a way to release data that suffices or satisfies not just HIPAA compliance, because people are more than HIPAA, and HIPAA, FERPA, and education system. As advocates, one of the things we hear a lot is we can't release that data because the numbers are so small. I'm telling you, in Vermont, we are never going to get over our race issues or our other issues of demographics until we stop using that as a shield. Again, like I said, HIPAA is a great thing in a lot of ways, and it does protect patients, so does FERPA. In a state like Vermont, we have to have a more difficult conversation than other states where concerns about patient recognition and identification is one of those things that comes up. And my suggestion, our suggestion, is that we create a demographic data responsiveness team. I sit on the Vermont State Police's fair and impartial policing committee, and sometimes we have these hard conversations about, oh, if we do this, is this going to be a problem? And to have the buy-in from community can be really critical for the Department of Health and feeling comfortable moving forward and knowing that they are being racially responsible in what they do. The other thing that we support is increased resources to the Department of Health. One of the things we're hearing is that we just don't have the people power, the time, to be able to collect this data or oversee demographic data in a cohesive way. So we support what are the funds that you need to make that happen? What are some of the other resources that we can provide from the community perspective to make those things happen? So those are the four things that we really support, is the increased resources to the Department of Health. We need to understand what they are in order to support that. The creation of a demographic data responsiveness team, healthcare provider reporting, raw data and percentages both statewide and an accounting level breakdown in terms of which providers are reporting consistently and which ones aren't. And then the big one, which is the state and county level racial breakdown of who's getting tested, who's infected, who's recovering, and who's dying. So like I said, it's pretty easy in Vermont for us to see diversity and equity as pet projects rather than as an integral part of the work. One of the things that I'm hearing anecdotally in the NAACP is a concern that healthcare providers and hospitals who were previously tackling issues of equity, diversity, equity inclusion, I'll just say DEI from here on out, that that was a big part of what they were doing in their facilities, that they backed off of doing that now. And it's been because we're dealing with a pandemic. Well, the pandemic is racial too, and we need to understand that as well. So whatever we can do to support those sorts of things or whatever you, as legislatures can do, as the legislature can do to help the Department of Health to be able to continue to in support that work is really important. The other thing is, is I know that many of you sit on other committees, I've seen you in different places. And I know that folks are really concerned about the COVID-19 cleanup, not just from a health perspective, but economic Vermont's population. I was just looking at the preliminary data from the census, we're continuing to decline. We know that people of color, we want to get out of those housing dense places, we want to get into places like Vermont, where the air is cleaner. Economically, there's a potential here for a benefit with a comprehensive health care response. People of color, we are great at using Google to find information. And we are doing it as we look for places to live. And what we want to see when we look at places like Vermont is that Vermont had a comprehensive racial, racially responsible health care response. And even though we have tiny numbers, it was really important. So this testimony in and of itself is really critical. So I thank you for giving me the opportunity to come here today. I know I speak really quickly. So if you want me to repeat anything, I'm happy to do that. And if anybody has any questions, I'm happy to field those as well. Thank you very much. It was it was actually very clear. And your comments about supporting the Department of Health and its efforts, I think are are very important. And how we how we walk that tightrope between HIPAA and transparency is also critically important. So thank you for that. You're welcome. Questions. Let's let's take one or two quick questions. If you have any committee folks. All right. I don't see hands. I see a hand. Lucy Rogers, and make sure you unmute yourself. Thank you for the testimony. I just was wondering. Director Davis mentioned the problem with our race data that is not self reported, that's instead perceived. I'm wondering if you have a perspective on whether it's more helpful to have race data that's perceived or to just simply not have that data at all. In other words, would it be a more helpful protocol to say never write down perceived race data only write down race data that's that's been self identified, or is it still better than nothing? I was just wondering if you could shed some light on that. Well, I think either one is dangerous, right? Not having any data at all at least tells us what's going on, right? So I'd rather have pure data. I think of it like a blood sample. You know, do you test a contaminated sample and, you know, go based on that. From my perspective, there is no excuse as to why we are not getting a static. Now, if the patient refuses, there should be a place for people to be able to say patient refuses, but they're like, we collect information about height, weight, sex. This should be justice standard is those sorts of things in relationship to the pandemic. Did I answer you at all? That answer, I guess I'm left still curious as to why it would be so difficult to put in a protocol that that race data is always collected and entirely self identified. But maybe that's a question that are left for the Department of Health. Yeah, I don't I share your the funnel meant I don't know why that that wouldn't be standard. Although I do know historically the relationship between marginalized groups and healthcare is not a good one. So we are reticent to provide that data unless people can tell us how it will be used, how it will benefit us. And, you know, what are the what is going to be done to protect me. So it really is a comprehensive ask that is, you know, may not be as difficult as, you know, eye color, hair color. Okay. Thank you. That was a good question. And maybe we'll circle around. I think it's a question not just for Department of Health, but also for providers, when they either perform the inventory themselves or ask patients to self report on their medical profile. Okay, any other questions? Thank you, Tabitha. I think we're going to switch order and we'll go to Mark Hughes first and then we'll move he's Executive Director of Justice for all. And then Amanda, you've been very gracious in allowing for us to put you after Mark. So thank you for that. Mark, welcome. Madam chair and just want to give a special shout out to the chair as well as my Senator Ingram. I'm here in Chittenden County, so I have to say that, you know, to all of the committee. I am Mark Hughes. You don't have to say it, but it really is appreciated. There's some people I got up there. And then of course, Representative Cheena is over there as well. So I just want to just give a shout out to all of you and just thank you first for all of the hard work. Again, Mark Hughes, Executive Director of Justice for all. I've been watching very closely the activities of the legislature in the dark week, as I refer to it as the dark week historically, as well as that, you know, that, you know, all the way up to that bridge that led over to this historic opportunity for you to be able to vote as a full chamber, a Senate chamber remotely. So congratulations on all of the work that you've accomplished. And also thank you for the work that you've accomplished as far keeping our government afloat. So thank you very much. As a racial justice advocate, oh, I would note also, I am also the committee chair or the steering committee chair of the racial justice alliance. We have people of color steering committee here. In fact, we'll be meeting tonight. We'll be talking about this meeting as well. Just so you know, the angle that we approach this from is an angle of that as we've approached all things from is with a prism of racial justice through a prism of addressing racial equity, inclusion and diversity across state government systems and more specifically mitigating systemic racism. That's the work that we've been doing up until now over the last five years. It has been as a result of the work that we have done that the racial disparities in the criminal and juvenile justice system advisory panel was created. Representative Lipper, we stand on some of your shoulders, some of the work that you guys folks have done here. That panel is still in full swing. The work continues and from that panel, an offshoot of that work happened. Some of that included work surrounding the human rights, the attorney generals and the human rights commission's task force, which I'll talk a little bit more about here in the future. I think that what's important to note with that task force is again, this focus on addressing disparities across all systems of state government. That's housing, education, employment, health services, access as well as economic development. It was a result as the output of that work that we went further and I want to thank Senator Ingram for the work in putting these bills forward. But with Act 9, the racial equity executive director, that's Act 9 special session 2018 as well as the racial equity panel, which exists and you just heard from the executive director of racial equity. I don't think anybody here would disagree that that wasn't a good idea to bring her in. I think that kind of establishes where we're coming from. Let me tell you a little bit about that report. First before I say anything on a qualify one thing, we're talking about racial equity. We're talking about systemic racism. We're talking about all of these things that pre-existed COVID. It's a very difficult conversation to come in and have this limited discussion because you best believe what I'm doing is we're having these conversations in GOV-OPS, we're having these conversations in judiciary, in house, we're having these conversations in judiciary, in Senate, in institutions, in corrections, in house. So I have been all over the legislature having these conversations and it's quite challenging from a position that I'm in because the structure of our government is not conducive for us to address this as an issue. A COVID-19, what is the relationship between COVID-19 and racial justice and or systemic racism? It is massive. It is a beast and I don't have time to tell you how many ways in which it is impacting us and it is unfortunate that I have to keep repeating myself but then I have to fine tune what it is and I'm saying to tailor it to that specific committee's particular mission. So we will talk a little bit about healthcare but no one understand when we're talking about high impact, high discretion decisions, high impact, high discretion decisions that anybody is making across the state that impacts the lives of Black and Brown folks across the state. I can guarantee you we will always be talking about data collection, we will always be talking about training and that is systemic racism training. We will always be talking about policy that is equity and inclusion policy. We'll always be talking about impact analysis that is racial impact analysis, existing and emerging policies and we'll always be talking about the appointment, the promotion as well as the hiring processes across this state. That is a global conversation and as sure as I'm sitting here, all of those other aforementioned elements we've yet to discuss in your committee and the only thing we're talking about today is health, high impact, high discretion decisions in light of a COVID crisis and the only thing we're talking about within that is just data collection. So just to be very clear about the scope of what it is that we're talking about, it is a monster and it is indeed affecting a number of folks and at highly disparate rates, adversely disparate rates of Black folks across the United States, we are contracting this virus and we're dying. That is the tip of the iceberg. Just as a little side note, I had a little conversation with TJ Donovan just yesterday and we're talking about because there is also an intersection of poverty, there's also an intersection of class that we have to talk about. Why? Well, why would you not if the average median wealth of an African American family is one-thirteenth that of the average white family? Why would we not be having that conversation? So yes, here in Decker Towers there's an outbreak here in Burlington, there's stuff going on there, but what's going on with public safety? Why do we have folks posted up? There's not a representative Smith that's trying to get your attention. Well, yes, he has a question and I'm wondering, do you mind if you're interrupted for questions while you're giving your testimony? Well, I'm going to defer to the chair. All right. So I think that Ryan, Representative Smith has his hand up. Let's listen to his question and then I think for the most part we'd like to hold questions till the end, but we'll do it now. Go ahead. I apologize for asking this question, but we seem to be straying from COVID-19 here and I think COVID-19 is the issue. Am I correct? Matt, if I might be allowed? Go ahead. COVID-19 is exactly the issue, Representative Smith, and that's why I'm here. And what I'm here to tell you is this is the same thing I hear from every committee. We seem to be straying from COVID-19. The facts are is that COVID-19 has exacerbated every issue that African Americans are struggling with as a result of systemic racism and I'm here to talk to you about one of them. So COVID-19, we're not for COVID-19, we wouldn't be having this conversation. So respectfully, Representative, this conversation is all about COVID-19. Well, everyone is struggling from it. Agreed, but we're talking about disproportionate rates. And if with your permission, if we can, as the chair had indicated, defer these questions till the end of this testimony, I'd be happy to speak further to those disproportionate rates directly to you. Thank you. Thank you. And as you're talking about disproportionate rates, as we heard from Susanna Davis, our data in this state is incomplete. So, but you are looking at and I think we're all very much aware of the disproportionality of effect across the country. So I think that's what we're hearing. So, Mark, go ahead. So again, I'll just go just for a little bit of effect just to share with you some of the things that we've done previously. And I think this is where the rubber meets the road because I want to talk about what we've been doing here. That report that the Attorney General's Human Rights Commission's report that was released by then Chair Karen Richards and David Scherr, just want to quote a couple of parts of that report covering housing, education, employment, health services access, as well as the economic development. This is what it says. It says, quote, if the state of Vermont is truly committed to addressing the racial disparities that exist in the criminal justice system and other state systems, it must undertake a system-wide analysis of the ways in which the state government actively and passively contributes to these disparities, collect data to determine our baseline and set goals for reducing those disparities across all agencies in areas of service, including recruitment, hiring, promotion, retention of employees of color, culturally and ethnically appropriate service provision in education systems that provide culturally appropriate curriculum and address racial and socioeconomic disparities in exclusionary discipline, as well as harassment and bullying. So it goes on to say that nothing short of a comprehensive data-driven approach will alter the landscape for Vermont's of color and indigenous folks. It's saying here that a small, you know, as a small state, Vermont has a unique ability to tackle and address these issues in a comprehensive and coordinated way. Now, there's a segment of this report that was devoted to healthcare. Now, this is a report that acknowledges almost about two years ago that we're struggling with challenges in all systems of state government as it pertains to racial disparities. In this area where it speaks of healthcare, it says, while there was evidence in 2010 indicating that people of color have lower rates of access to healthcare, including insurance, a personal doctor, or lack of money to pay for healthcare, the issue of health disparities goes well beyond issues of access. People of color also experience higher rates of diabetes, asthma and obesity, health risk factors, smoking, lack of exercise, poor nutrition are all much higher among people of color. And it goes on and out to skip over this last part in the interest of time, but it says these Vermonters are four times more likely to report poor health or fair health compared to Vermonters who did not experience physical symptoms. And the reason why I wanted to kind of breeze over part of this report is just to indicate, and I think it's importantly, we've already started doing some of this work, we've already decided that, you know, we have racial disparities across the entire system, we've already indicated that it was important because what we did is as we hired ourselves a racial equity director, those five categories that I named regarding data collection and training and policy and picked that impact analysis are a component of her areas of responsibility, she didn't go into detail on those. And we've already indicated through this report, though we haven't gone back and revisited it, that data collection is very important. So yeah, I think, you know, some of the work that we're doing here aligns with some of the challenges that we're having and why as Tabitha said a little while ago, we're not already collecting the data is befuddling. In fact, it's kind of troubling that, you know, in most systems of state government, we keep having to have this conversation, why would you not, why would we not as a state in areas where we understand there to be high impact, high discretion decisions being made on folks outcomes, that we why would we not be collecting that data. So I want to close with just basically saying there's other work to do. And I think that, you know, yes, this is, you know, we need to do some stuff right now to address what we're doing regarding COVID. But I think prior to this COVID conversation, clearly, we had already, we had already identified the fact that there were some things that we could do better. And I think as we begin to address policy, because that's really the, you know, the whole point of this data collection is, you know, targeted outreach policy measurement, and so forth. As we begin to continue to do this work, you know, I'm thinking that some of the work that we're doing, I think we should have an eye on where we come from so we don't return to the status quo. So I saw a few hands go up, I had more of it, I'm going to stop because I know that Amanda's behind me. And I can come back and talk to you. I think you kind of got the sense of what it is I'm trying to tell you. There's more. So if there's any questions directly from me, Representative Smith or anybody else, I'm glad to take those. Okay. Thank you very much, Mark. I think that you have hit on a key issue, and that is while we're discussing COVID-19 and making sure that we have the right input data for that specific for the pandemic and it is an emergency situation, that we don't forget the need for ongoing data and information so that we can make systemic change. I think that's right, Madam Chair. I think we get that. And I think that Susanna's comments were very helpful in that area as are yours. So thank you. Questions for Mark? I don't see a hand. I hope I'm looking at all the screen. Let me just check my other screen. Anyone? I'm just going to suggest that we move on to hear from Amanda and then maybe there'll be questions directed at any number of our witnesses so that we can hear out here the other witnesses. Thank you, Mark. Thank you. Thank you, Mark. So Amanda Garces of the Human Rights Commission. Thank you, Amanda, for being patient. And we have, we have, we probably could take more than nine minutes for your testimony. We might go past 12 o'clock if other folks have meetings. I'm, I do apologize for that, but we've had a lot of good testimony this morning. So Amanda, thank you for being here. Thank you, Madam Chair, and thank you everybody for having me. I will try to be brief as I also took some stuff out of my testimony. For the record, my name is Amanda Garces. I am the Director of Policy and Education for the Human Rights Commission. I do have an accent. So if anybody has wants me to speak slow, just say the word. I have to say that all the time, just in case because I am Colombian and I speak fast. So, so as you know, the mission of the Human Rights Commission is to promote full and civil and human rights in Vermont. We enforce the laws over which has over which we have jurisdiction through investigations, constellations, and litigations. Through COVID-19, we have had a lot of concerns regarding the Asian American backlash that is happening right now in the state. In March, we submitted a press release to inform communities that we are here. We also have an incident report and we've started to have some come in and I really encourage everyone to share the incident reports so that we have some data on what is happening in our state and that we can also support the communities. On March 9th, on April 9th, we submitted a letter to the Department of Health, the Commissioner, and I submitted it for the record so it's there. And it was about data collection and why we need it. Everybody else has spoke about the disproportionate impacts that is having, that COVID-19 is having in African American populations. Latinos in New York have the highest rate, the highest death rate. So we want to be able to see what is happening. We also want to extend that race data. It's a call that is happening Nation One to also include language and let me just scroll through my notes so that language in addition to the race and ethnicity data that we are seeing that there are issues with language access. And so that is data that people are asking for. Experts have asked to extend that data to gender identity, sexual orientation, and disability status. We know that there is this proportionate care that happens within these populations and we want to be able to support. In Vermont, we are concerned about our farm worker population as well and the access that they have. We know that testing is free but the treatment is not and for undocumented population, we are trying to see like what can the state do. There's fewer resources since the Open Doors Clinic have closed. There's some fear that is happening nationwide by the undocumented population but also by all immigrant workers. So that is something that we want to start thinking about how this is affecting our farm workers and documented or not and how that can be supported. So I cut a lot of my testimony. The other two parts and equity issues that we want to make sure that we're bringing to the table is what is happening with our disability communities and how data is also really important in this situation because how we respond is crucial as well as people with psychiatric disabilities who rely in support of family members and friends who maybe denied access to the facilities that they are going through. So I think that here at the Human Rights Commission, we are looking at the vast majority of the protected categories that we have and how this is impacting them and to add to the language barrier also ASL. It's like a key issue. We are seeing that a lot of the communities are not receiving a lot of information. A group in Burlington created a website with some of the information is in all the different languages which is really powerful and important for people to be able to hear what is happening in their language but I think as a state we need to do more and I think related to this crisis and being able to really respond with language with ASL and understanding our marginalized populations so that we respond as a state with love and support and that we're thinking about them. Thank you. I think that you've raised again I think raise some issues that while we've heard some very compelling testimony for example on disabilities and what happens when kids with disabilities are at home with their parents and need the medical or other care and how that is covered, how we pay for it. What we're hearing is a need going forward that we need to look at that systemically going forward. There are some common themes I think that we can pull out of this and certainly the Senate Health and Welfare Committee has taken testimony on the disability issue but it is really difficult to resolve that not just during an emergency but outside of the emergency. How much do we value the people who need the care that they may not be getting. Amanda thank you for your testimony. Are there questions for Amanda? Let me make sure I'm yes. Representative Christensen go ahead thank you. Hi Amanda thank you for being here and you said there was an uptick in Asian American incidents and we've read about I think one or two in the newspapers. How prominent is that and then I have another question. Now we just started our collection only a week ago and we've only had a few but what we've collected from like the hear say this happened to my friend this happened to my friend in communities which is why we decided to do the incident recording. So that is happening and it's happening in you know in a small level of children just not you know hearing there was families there just walking on the street and being harassed there was one incident this was not an incident reported that I just heard from someone who was walking into the store and then they started telling you brought the virus and so those things are happening that we need as a state need to be able to respond really strong that it is not that that that is not acceptable and that is not how we relate to our communities. And my other question is about translators in the hospital in health care settings. How prominent is that or how bad is it that we don't have translators. I know that it's very difficult at the Human Rights Commission so we've had some cases and although I cannot speak to anything as specific because everything is confidential but I can say that you know and as a person who whose language is the is who's who came to this country not knowing the language and then learned it and had to translate for families I know that it's really hard nationwide is really hard there's call for just volunteers to be calling in there's the issues that are compounded right now is that a lot of the translation services in Vermont are also telecommuted which is very difficult and some of the people that are higher through the might not have the medical language so if if I was to translate about a disease that I don't know anything about is really hard because then you're losing a lot of that information so I think we have to do better at really getting qualified translators and interpreters that understand the medical language to be able to translate that information and and you know I could probably get other people to come and testify on that specific thing of what is happening on the ground right now but I do know there was an article on ProPublica regarding the impact on on language barriers and even in normal times so this is just like triple in okay thank you yes thank you I think that the language barriers you're speaking about the use of the Spanish language of course are a number of our migrant workers are in that category and we probably should pay attention to their health care needs a little bit and I think representative Lippert is next yes well let me pick up on that and say that since we're reaching the end of our time here this morning uh center lines and I've discussed this neither of us have made a firm agenda for next week we're both going to be doing some planning later today but one of the issues that I hope our committee perhaps our joint committee will look at is access to health care for our migrant workers documented and undocumented we've been doing some research in the background to better understand what the limitations are or are not and I think it's important for us to to look at that both in the context of COVID-19 and more broadly and then secondly also the issue of disabilities our committee has not had the opportunity to take the same kind of testimony perhaps the senate has but I know there are additional disability access issues during COVID-19 specifically around persons with intellectual challenges and psychiatric disabilities and having someone be able to be with them as they are seeking treatment or being hospitalized even and again I hope that either as our committee separately or jointly that we look further at those issues in the in the next several weeks I you know what we we can talk offline about that bill but I think our committee has taken significant testimony it might be that what we've heard can be made available to you either through the YouTube recording or some of the testimony that we've received so we can talk about that. Brian Chena representative Chena has a question. Yes I think it's mostly for Amanda okay so the question is in Massachusetts I heard that they were able to expand their state's emergency Medicaid for migrant workers do you know about this and do you have any thoughts about how that might we might apply something like that in Vermont? Yes and I know I don't don't know much I was reading about it that too and I think migrant justice is also doing some extensive research on that so I would encourage the committee to invite them to speak on that and we can probably get some other experts to talk about it so but I think that's a great idea and it's it's also happening in New York and Oregon I believe. That that is something that Representative Lippert and I have been looking at with uh legislative testimony yeah so we will take testimony on that thank good question Brian. Thank you and thank you Amanda. Representative Rogers. Thank you Amanda. I was just wondering from your perspective it seems like there is progress being made on the collection of self-reported race data and I'm wondering if you think it would be helpful to have the legislature address it this issue in bill form to kind of more formalize the expectations or if you think that sufficient steps are being taken without having a formalized expectation in bill form. I think that Susana spoke a little bit about the the conversation that she's had with the Department of Health I think that there is a really good intent to collect the data and I would defer to Susana and the conversation that she's had with the Department of Health for that question and I really appreciate um like that you know there hasn't been any pushbox so I think that I think for us to come as a collective to really you know ask for what we want to see on the ground so that we can support and respond as a state is really important and I think the commissioner and the leadership is really hearing uh what you know what we are saying so I don't think it's necessary but that's just my personal opinion. Okay and I mean we've heard compelling testimony from a number from everyone today about the importance of not just looking at this during the pandemic but going forward and understanding that what we're seeing during the pandemic might represent systemic needs need for systemic change. I've got another request here okay there's a dialogue going on that I can I will ignore for the time meeting sorry any other questions seeing no other questions yes is there this is Susana Davis again please I just wanted to jump in um on the topic of upstream factors and the relatedness of COVID-19 response to other issues I appreciate Representative Smith's question slash comment about uh how close do we how how narrowly do we focus on the issue of COVID-19 it's a fair question and one thing that I did not mention when I said that I worked for the New York City Health Department was what I did there I was their director of health and housing strategic initiatives and one of the biggest parts of my job was explaining to people why the health department gives a dam about housing and oftentimes I would cite statistics that said well the average uh emergency department visit costs five thousand five hundred dollars that's five thousand for an ambulance and 500 for the actual ed visit and when we talk about uh marginalized low income and vulnerable people needing emergency and acute health care it costs far less to stably house them and stave off a lot of the triggering factors that lead to acute and chronic conditions than it does to routinely treat them so I I I say this to encourage the committees to think about potential creative points of collaboration with your colleagues and other committees and other parts of the legislature for example um your focus as a health committee is not just on responding to ongoing public health concerns but also on prevention and so thinking about things like housing and all of the barriers to adequate and affordable housing that exist absolutely has the downstream impact that's going to help us mitigate things like a COVID-19 or looking at the way the job creation and economic stability which is absolutely impacting people who are not able to work right now during the pandemic so I do encourage and I've said this in the senate committee on government operations as well I do encourage you all to think creatively and think outside the box at ways that you can impact policy that don't appear to have a direct relationship to health but that absolutely do impact those public health events thank you for that and just so you know you're speaking to the choir we are all we are all on the same page in the same key and we do appreciate that one of the things that we unfortunately with the pandemic I think it's intruded in the process of hiring a prevention chief at the in the office of administration which is something that we've all worked very hard to to have happen and to get to continue the work I think that all of us agree that you pointed out needs to be done thank you we appreciate that I think I have another hand up let me see uh representative cheena did you have your hand up again yeah all right go ahead this will be the last one unless there's another compelling question okay and it's a question to all all of us on the on our committees um I may be more than the um advocates and and uh public servants and people speaking with us today um which is I'm hoping that we can dig into this more like can we maybe check back in with our witnesses in a week in a couple of weeks I'm a little concerned that about the pattern in in government or in systems where people talk about an issue once and then they check the box and they say we took our testimony on racial and ethnic disparities we did that um and I think part of what came up in the testimony and I think what mark mark's point was that the current crisis is amplifying and magnifying and I guess it was in many of our witnesses testimony that the current crisis is magnifying the existing disparities and the existing problems that are that are built into our system and so when we talk about the emergency response you know if our emergency response is all we do then are we just going to go back to the way things were when this is over or are we going to learn from this and do something differently after and so I guess my question is can we please check back in with the witnesses in a couple of weeks it might take some time but check back in with them to see how things are going and to see what recommendations you all might have besides data collection other actions you might need us to take. Okay thanks Brian I think that does summarize the issue for us and and ensuring that we look at systemic issues going forward not simply those related with COVID-19 but right now the data collection seems to be an imperative if we're going to understand the effect within our racial and ethnic minorities in our state so um but we I think there isn't one I don't think anyone wants to forget the systemic issues that we're facing so thank you. All right other no other quick question representative Lippert last couple of words. Well I I guess I just given our time and David Englander spoke briefly earlier but I appreciate the Department of Health through David being here and hearing the testimony even if we're not hearing going to have time to have David speak at any length today I think that was I think it's very important that the Department of Health be responsive and has been responsive in many ways but we understand there's always there's there's definitely more to do and again thank you for being here David I'm Senator Lyons I'm not quite sure how to proceed at this point since we've gone past our time. Well here's my suggestion I'm going to turn to David I know that you've been listening in I think our goal might be to have you come back at some point. I think when we when we I would suggest that when we follow up perhaps in a few weeks because I do think we should also follow up as Representative Chiena suggested I mean this is a this is a this is a long term issue this is not something we'll resolve in a few weeks by any stretch but in terms of this specifics around data collection and the COVID-19 I think we should come back to this and we should invite the Department of Health as well as some of our witnesses to help see where that we've progressed. We'll do that but David I want to turn to you and ask you about your being available to bring us up to date on on some of what the Department of Health is doing. I know that Susanna talked a little bit about it but your comments. Well so again my name is David Engler I'm the Senior Policy and Legal Advisor at the Commissioner of Health I'm delighted to be with you. I'm trying to think of in our in with how much time would you like me to take Madam Chair I could do it in a minute if you'd like I could issue a series of declarative statements that would be helpful. Why don't listen why don't you go ahead and do that we still have a critical mass here okay and and then we will we will look to invite you back as more data is collected and as this whole process matures. Sure so it's been incredibly helpful both to read the letters from various folks as well as hear the testimony. I'll say this that we were collecting information from the Department of Health and we were collecting it inconsistently as of last week or now collecting it consistently our expectation is that ethnic graphic data is going to be collected a hundred percent of the time that information has now been posted or I should say it's available on a daily update starting yesterday we expect it will be available every day on our public dashboard as of Friday. We're committed to marshaling the resources necessary to go back and get the the unknown data from the 420 individuals from whom we don't have data that will take marshaling some resources with the assistance of the administration at large and our brothers and sisters and other agencies. The work I can commit that we'll have any conversations with regard to additional data that could or should be required in order to have a more comprehensive understanding of what's happening on the ground. Director Davis spoke eloquently and and with more perspicacity than I could about the issue and about the kind of data that we're collecting and that we that we can collect. I certainly agree that that HIPAA the federal the federal and state privacy laws can be too blunt an instrument in terms of it doesn't allow us to see information there would be that would give us a view into what's happening on the ground and you know we'd be happy to have a conversation about the way that that can either be the way that we can collect that information a way that also is respectful people's privacy and the law. Good you know as you're as you're talking about that I think we probably can think of some possible creative ways to do that so thank you we will we will have you back at some point. Good thank you. All right and Donahue are you back I did you had a question a long time ago or was it that you were leaving I don't know. Hello no I did have a question I think it can wait it was a broader issue about the question of self-identified versus yep so thank you very much but I've been listening in because my internet failed so just on the phone. That's such an unusual problem. All right thank you we will we will continue with this topic and try to try to reassure folks that we are doing something moving forward. Thank you all it's been a real pleasure and we'll see each other tomorrow morning at 9 30 so take care. 9 30 good.