 All right. Good morning. Thank you. It is May 17th. And this is the Senate Health and Welfare Committee. We are meeting today. It's a Monday, but we're meeting between 12 and two to consider a joint resolution from the House number six. So we've asked a number of folks to come in and testify. But before we get to testimony, we are going to ask our Ledge Council, Katie McClenn, to help us understand what is JRH 6. So, Katie, thanks for being here. Sure. Katie, make that an Office of Legislative Council. So do you like me to pull up the resolution on this shared screen? I think that's good. Thank you. Okay. Are you seeing the document? We have it. Okay. So this is JRH 6, a joint resolution relating to racism as a public health emergency. There are a number of whereas clauses while walking through them. First, whereas stark and persistent health inequities exist in the United States based on race and that are caused by systemic racism. And whereas systemic racism is a principle of social determinant of individual public health impacting economic employment, education, housing, justice, and health opportunities and outcomes, all of which further adversely impact the health of people of color. And whereas the COVID-19 pandemic is now exasperating these inequities and Black and Latino people in the United States have been nearly three times as likely to die. And whereas the same inequities exist in Vermont and during the pandemic through the Black residents comprised just over 1% of Vermont's population, they account for approximately 4.8% of the total confirmed COVID-19 cases as of December 16, 2020. And whereas research and experience demonstrate that Vermont residents experience barriers to the equal enjoyment of good health based on race and ethnicity. And whereas incidence rate of COVID-19 for non-white Vermonters is 74.2 versus 26.2 for white Vermonters. And specifically the incidence rate for Black Vermonters is 225.7. The incidence rate for Asian Vermonters is 61 and the incidence rate for Hispanic Vermonters is 41.7 and the incidence rate for other races is 20.5. Whereas while there are not statistically significant differences in the rates of preexisting conditions, such as diabetes, lung disease, and cardiovascular disease among white and non-white Vermonters, there are disparities in the rates of preexisting conditions among Vermonters testing positive for COVID-19, which suggests that non-white Vermonters had a higher risk of exposure to COVID-19 due to their type of employment and living arrangements. And whereas 36% of non-white Vermonters had household contact with a confirmed case of COVID-19 as compared to only 20% of white Vermonters. And whereas according to the Department of Health's 2018 behavioral risk factor surveillance system report, non-white Vermonters are statistically less likely to have a personal doctor, statistically more likely to report poor mental health, more than twice as likely to report rarely or never getting the necessary emotional and social support, significantly more likely to have depression, significantly more likely to have been worried about having enough food in the past year, and significantly more likely to report no physical activity during leisure time. And whereas non-white Vermonters are disproportionately represented in the total number of patients and the highest level of involuntary hospital beds in the state, comprising 15% of the patients admitted to the Vermont psychiatric care hospital between May 1 of 2019 and April 30 of 2020. And whereas social determinants of health are underlying contributing factors of the foregoing health inequities. And whereas 21% of black Vermonters own their own homes, well 72% of white Vermonters own their own homes, and nationally 41% of black Americans own their own homes. And whereas the median household income of black Vermonters is $41,533, while the median household income of white Vermonters is $58,244. And whereas in 2018, 23.8% of black Vermonters were living in poverty, well 10.7% of white Vermonters lived in poverty, and 57% of black Vermonters earned less than 80% of Vermont's median income, while 43% of white Vermonters earned less than 80% of Vermont's median income. And whereas about one and two non-white Vermonters experiencing housing problems, which is defined as having homes that lack complete kitchen facilities or plumbing, having overcrowded homes or paying more than 30% of household income towards rent, mortgage payments and utilities, and whereas black Vermonters are overrepresented among Vermonters experiencing homelessness, and that they make up 6% of Vermonters experiencing homelessness while making up approximately 1% of Vermont's population. And then we get to the resolved clauses. So now therefore be it resolved by the Senate and the House that racism constitutes a public health emergency in Vermont, and be it further resolved that the legislative body commits to the sustained and deep work of eradicating systemic racism throughout the state, actively fighting racist practices and participating in the creation of a more just and equitable systems, and be it further resolved that this legislative body commits to coordinating work and participating in ongoing action, ground science and data to eliminate race-based health disparities and eradicate systemic racism, and be it further resolved that the Secretary of State be directed to send a copy of the resolution to the Governor, Chief Justice, the League of Cities and Towns, all Regional Planning Commissions and the Vermont Racial Justice Alliance. All right, thank you. That was great. Why don't we take it down good? And so Katie, just one other thing. I know that we have on our webpage references for each of the whereas clauses that we won't go through today, but the committee has seen that they had access to it yesterday, and it is on our webpage so people can reference the supporting documentation for each of the whereas clauses. So questions for Katie. Senator Hardy. Thank you, Madam Chair. Katie, my question actually is about the very last resolved and whether that is the standard list that is sent resolutions or if it was if there's something special about that list. Yeah. You know, that's a good question. I very rarely draft policy resolutions. This is my second and 10 years. So I'm probably the wrong person to ask about the standard list. I would assume that the Vermont Racial Justice Alliance isn't often on every resolution that moves through. But as for League of Cities and Towns, Regional Planning Commissions, I couldn't tell you how frequently they show up on policy resolutions. Okay. It just seems like a strange list that there were there are other entities that I would include in addition to this or instead of given the content of the resolution. So that's why I was asking if there's a standard list or if this was specially tailored. So I don't know. In my experience here for many years, I think there's been some variability in who gets resolutions. We can ask Taylor Small, when she comes in, she's going to be a little bit late getting her shot this morning. Second shot. We can ask the House for clarification if there is any. And then we'll also ask others who have been involved with this in the House. We'll do that. Okay. Thank you. Yeah. So I'm going to move now. And I know there are other folks here with us that appear on the agenda. And just to give you all a heads up, I think that after Boyang testifies, then we'll ask Senator Brock to testify. And then Mark Hughes and Dr. Avila, we may ask you to testify sometime before that. So the agenda is fluid. Just FYI. All right. Dr. Levine, Commissioner Levine, thank you for being here this morning. We greatly appreciate your time and attentions. And we welcome your testimony. Thank you. May I share my screen? Yes, you may. Nellie, can you make Dr. Levine a co-host? He should be one and should have that ability. Okay. Do we have this PowerPoint? You're showing your notes. Yeah. Well, I don't have any notes, but I want to make it so it doesn't come out. Do we have this up on our webpage as well? It should be there, yes. Okay. Because if you're having difficulty, we also can pull this up. Well, let me go go back to your go back to your the other. It is under display settings, Dr. I think we're able to swap the two. No. Yes. It doesn't want to... Or you can go back to your toolbar. Okay. Now go to from current slide. Whoops. Now go back to your toolbar. Okay. But we'll try and get it. Now we'll go to slideshow, I guess. Yeah. Go to that. It's somehow not letting me do that. But, you know, if it's not too distracting. Can you just go and say from beginning, does that do a thing? Does that do it? It didn't. It doesn't change it. If it doesn't do it this time, we'll pull it up on our screens as well. And we'll deal with a smaller font on your shared screen. So do you have the slides going? Yes. Committee members do have it. So we've got them pulled. Okay. Yeah. And I know you have time sensitivity here and want me to condense what I say. So let me just, I'll just roll. And you won't need to read everything on every slide anyways. Thank you for having me, Commissioner Mark Levine. Whoops. Did we just lose it? Yes. Beautiful. There we go. There it is. We hope. All right. So I'm going to merge a little discussion about racism in with health equity and the health department and this resolution. And the bottom line is we see this as you do as a public health issue. Everyone knows about the state health improvement plan that I've discussed previously in front of your committee, which is built on the concept of health equity. Health equity has to do with the fair and just opportunity to be healthy. And it exists only when that opportunity is present. And we find when there is inequity, it is related to socioeconomic disadvantage, historical injustice, and other systemic inequalities. And that I will not go into all of the text below to save time, but I would like to, at this point, discuss not only health equity, but the concepts of racism, structural systemic institutional. These terms are all interchanged when it comes to racism. Suffice it to say that these are the less overt forms of racism than individual racism would be. They are embedded within the laws of a society or an organization or the policies like redlining. These are things that lead to discrimination in all aspects of an individual's life, which I will show you mean the social determinants of health and public health lingo. And they historically and currently put people of color at a disadvantage from the get-go, which results in health care disparities and the concept of health inequities. Health inequities. Again, the definition of health equity, I pretty much gave it already. We'll move on to the next slide. Dr. Levine, your slides are not moving. We still have the first slide up. Fascinating. Yes. So I can read the turquoise slide that talks about health equity. And then the next slide is social determinants. But the only slide we're seeing on the screen is the first one. I thought we had mastered Zoom and all of that and not done this to me before. Would you like Nellie to put the slides up and then you can ask her to advance them? Sure. Nellie, can you please do that? Yep. Dr. Levine, could you just take yours down or I could do that for you? Yep. I just ended your screen sharing and give me one second. And Dr. Levine, when the slides go up, will you be on slide number five, social determinants or a pass-up or before it? Yeah. That would be fine. That would be fine. Slide five, Nellie. Perfect. Good. One more. One back. Right there. So the social determinants of health are the conditions in which we are born, live, grow, learning, work in, and age in. And it's the social, economic, and physical environment that affect a wide range of health. If you look here in the four columns to the left, you'll essentially see that economic stability, meaning the opportunity to accumulate wealth versus being poverty. The neighborhood and physical environment, meaning do you have stable and safe housing and access to playgrounds, parks, et cetera. The educational environment, which goes without speaking, and then access to healthy food versus hunger. All of these obviously lead to the health outcomes regarding life expectancy, morbidity, how much we spend in our health care system. Now, how do these translate into action? If you go to the next slide, we'll use asthma as an example. This is Vermont data, basically showing that if your educational status means that you didn't graduate from high school and or your household income is significantly closer to the federal poverty level, your rate of asthma is much higher than Vermonters who have higher levels of education or household income. On the next slide, we're going to skip that one, go to the next one. We can look at this in the light of a health equity lens, because health inequities really exist across all aspects of public health. And we'll show that asthma as well as COVID can be exacerbated depending upon the systemic conditions. The next slide is from the Candom Coalition, which is from New Jersey, which essentially shows that the success in improving asthma in the populations that we just saw doesn't come from giving a better medication or teaching someone how to use an inhaler or educating them more about their disease. If you apply it equity lens, you learn that indeed, if you want to improve the asthmatic condition, you improve the living condition. And the fact that you're living in a situation where you may be more exposed to cockroaches, rodents, mold, secondhand smoke, all of these, as you can see, are characteristic in the higher poverty versus lower poverty parts of this slide. Candom Coalition showed that if you improve of those conditions, the rates of symptomatic and exacerbated asthma go way down. It turns out if you know anything about Candom New Jersey, it is way more diverse than Vermont. And those living in these higher poverty circumstances were quite frequently, not exclusively, but quite frequently people of color. And they came about living in that area because of the structural inequities that we've discussed. On the next slide, we talk about something that we developed in Vermont as part of the COVID response, which was our health equity and community engagement team, to really understand how to practice both education prevention and outbreak response in a far more robust way than we could early on in the pandemic. And we learned through some of the outbreaks, especially in the Burlington, Winooski area, that you really need to apply a health equity lens to really understand what the problems are and how to resolve them in a very collaborative and high functioning way. So the next portion of my presentation, which is just a couple slides, goes into exactly what we learned from the pandemic about health equity. So if you could advance to the next slide, and then the following slide, even though in Vermont, people of color are a very small percentage of the population, they turned out to have an inordinately high rate of cases of COVID. You can see it in percentages in the pie graph, but more importantly to the right, you can see that the rate was more than twice. And this has changed at various times in the pandemic. It was actually more than twice earlier in the pandemic. Same for the lower left hand part of the slide, which shows a higher rate of hospitalization, which here doesn't look as impressive. But until the more recent surge we had, this was always two to three times the rate in white non Hispanics. Some of this is determined by an excess of diseases that predispose people to a more serious case of COVID, which are illustrated on the right. So what are some of the contributing factors that lead to these disparities in the BIPOC population? They're illustrated on the next slide. And essentially, it is systemic and structural racism and their impact on the social determinants of health, leading to higher rates of having underlying medical conditions, not from a genetic standpoint, but from the impact of the environment that one is living in. People of color also tended to have jobs that were more public facing, putting them at higher risk, and requiring transportation to those jobs, which was more public facing, increasing the risk. We learned also about the increase in rates of living in multi-generational or congregate housing situations, which of course is a risk factor for a respiratory virus that can be transmitted very easily. You may have jumped a slide or two ahead, but this slide, the rationale for prioritization, basically shows that not only did we have all of the factors that I just mentioned working against the BIPOC population when it came to these disparities, but we had a disparity in rates of vaccination. That was quite large, as you can see. This was sort of the final impact on us in policy setting to not only do all of the things we were trying to do to enhance the BIPOC population's opportunity to be vaccinated, but this was sort of the icing on the cake, if you will, when we saw this and said, this is way too large a gulf between non-Hispanic white and BIPOC, and basically said that BIPOC population was a true priority population to be moved ahead of others. I'm happy to report that that gap is now at 5.8% instead of over 13%. You can move to the next slide. That illustrates that. And now you can move again. I guess those were a little bit out of order in the deck you had, sorry, and I've already covered this one. So we'll move to the last couple of slides. I'll move ahead another one and another one. Getting to the resolution at hand, as you're all aware, Chittenden County has had a similar resolution. I wanted to point out that we thought this had such importance that the Department of Health signed on with numerous other Chittenden County organizations to declare racism a public health emergency. The governor's racial equity directors, Zana Davis and I, announced the state's intention to support and collaborate in this regional public health effort. I want to point this out because I've read what was just presented at the beginning today, the entire resolution, all of the wear-asses and resolves. And it's really important that this have a little meat to it, if you will, and really set things off in a proper direction. And one thing on the last slide I want to call your attention to, if you could just advance to that, is that to sign on to the resolution in Chittenden County required you to list immediate actions you would take as an organization. So these are the three that the Vermont Department of Health anteed up, if you will. Number one was to, again, looking back at our state health assessment and state health improvement plan, continue to deliberately engage people of color in dialogue about the issues facing them and the solutions at hand. We didn't develop a state health assessment or a state health improvement plan in a top-down approach or in a set the table but not have the right people at the table. This was an example of nothing about you without you as the lingo went. And everyone was at the table, whether you were determined by racial factors, by gender identity factors, by socioeconomic factors, disability status factors, etc. All of the populations that traditionally suffer from healthcare disparities in the data and healthcare inequities in their lives were at the table. So we continued to do that. Secondly, we committed to striving to eliminate these inequities across health and healthcare and health systems with making sure that all of the support systems were available, accessible, affordable, coordinated, culturally appropriate and offered with cultural humility. That's obviously an ongoing process that the Health Department continues to be very dedicated to. And lastly, with regard to COVID itself, the entire nation was struck by not having the right data from the get-go and not collecting that with great consistency. We committed to all of the above and now we have highly consistent collection of data about race and ethnicity and preferred language that has informed us as we've gone through the rest of the pandemic. I would love to have said we were there from the beginning, but in an expression of cultural humility, I can say we clearly were not and that we are learning every day. So I just present this to you because I think it puts a little more meat on the bone, if you will, when it comes to not committing to a resolution, but also beginning that process of action plans, knowing we're dealing with historical injustice that doesn't just go back a decade or a generation, but it goes back several centuries. And we can't fix it in one fell swoop, but we can certainly start that lengthy process and try to accelerate it as much as possible. Thank you for allowing me to testify today. Thank you, Dr. Levine, Commissioner Levine. Nellie, why don't we clear the screen and then committee questions for Commissioner Levine? Senator Hardy. Thank you, Madam Chair. And thank you, Dr. Levine. My question is actually to your last point where you were talking about the things that the department committed to in signing on to the Chittenden County Resolution. Are you suggesting additional language in this resolution that would require commitments beyond the three resolves? Do you have suggestions? Yeah, I don't want to complicate your work or your life. And I think most of the people who are going to be advocating for this today are going to want it to just happen. So I don't want to institute delay, but at the same time, I just want to make the point that I wanted to have a sense of real commitment to it. And if it takes actually some more discrete action plans, that would be fine. But just make sure that that sense of commitment doesn't get lost in translation between having a resolution and then a journey for the session and then coming back and who knows what happens next time around. Because this is, if we're going to call this an emergency, a public health emergency, we have to have a little more sense of urgency to the follow-up of the resolution. Yeah, I agree. Thank you. And I do understand our time is tight, so, but I agree that we should have some more action plan oriented language. But thank you, Dr. Levine. Senator Hooker, and then I'll, I'm saving my. Thank you. Thank you, Senator Lines. And thank you, Dr. Levine. To your point about the action plan or to Senator Hardy's point, this is the plan that this health department has implemented in the resolution that's in Chittenden County. So the department will be doing all of the things that have been itemized here, whether or not we add language to the legislative resolution. So it seems as if, you know, we're getting it, we're getting, getting the action. And I do ask, have a question about collection of data. And could you describe how you're doing that, especially with Indigenous Vermonters? You know, how, what particular texts are you taking to collect the data? Yeah. So, you know, most of the data that we collect is, like when it comes to vaccination, when it comes to public health surveillance of disease and hospitalization and death frequency, when it comes to testing, all of that race is actually included intentionally in the data collecting tools. It wasn't always that way. So across the board, race was not always in there. So we made sure it's always in there. But then being in there doesn't mean it's consistently adhered to in those who are collecting the data. So what happened nationwide was the race area was left blank because of laziness, because of lack of concern, because of who knows what reasons, so that we had a lot of information on people's insurance status, but we didn't know what race they were. And that was inexcusable. So the fact is, now there's an adherence to making sure the data is collected uniformly and consistently, not just that it appears on a intake form that a health department would use. And in response to your other part of your question, all you've seen is what the health department says we're going to do. In those three action points, the 30 organizations all had points they came up with, some of which have a public health angle to them. And I don't want you to think that the three things I came up with are all that public health should do. But these are things we could start to deliver on in the midst of a pandemic that were really required at this point in time. But the breadth is far more than what you saw on that one slide. And that's the whole purpose of a state health improvement plan is to really force us to address these issues in as urgent a way as possible. And a state health improvement plan has a five-year duration. And we're already through more than a year of it. So there is some urgency in getting to that. So thank you. And as I'm looking at the whereas clauses, the resolved clauses that we have in front of us, it does commit the legislature to evaluating what we need to do. I think for us to establish a plan right now would require extensive testimony about what kinds of policies exist within our educational institutions, what policies exist within our hospitals, within our other health care facilities, within our drug treatment facilities. And it goes on and on. So for me, this resolution establishes some goals. It's like working with climate change. You put your goals up to reduce carbon dioxide and other emissions. And then you say, okay, how do we get there? And you have to go through transportation and home heating and everything else. So we'll have to ask Taylor Small some questions about the resolved clauses and see what level of conversation the House had as they went through this as well. But I appreciate that. And it's a journey. You're right. It's the beginning of a journey. But I didn't draw on the map yet. Right. I just didn't want the word emergency to not have impact either. Yes, you're absolutely right. And that's exactly why we're having this meeting today after our committee's been shut down. Perfect. Yes, exactly. So any other questions for Commissioner Levine? I do want to reiterate something that you said, which I think is pretty key in that you said that the term systemic racism includes thinking about institutional policies, situational policies within organizations, not individual actions or behaviors. Did I get that right? Yeah. Okay. It's across society, across institutions. Right. I think sometimes the confusion is that we're targeting individuals rather than the policies that have brought us hundreds of years. Yeah. Okay. And the individual behaviors often have lost insight into the fact that they're actually being influenced by these historical injustices that have gone on so long. Right. And then we have events, social and other events that wake us up. So we've had some of those recently. Any other questions? We don't, we could get into a long conversation, Commissioner. I shouldn't do that. Okay. Representative Small is here with us. I hope your shot went well. Thank you so much, Senator Lyons. It did indeed. Good. Well, thank you for being with us. And we did go through the resolution as drafted by your committee and a couple of questions emerged. I will let Senator Hardy ask her question first, and then you heard the conversation about the resolve clauses. So I'll have a question about those when we get there. So Senator Hardy, you had a question for Representative Small earlier. Right. Thank you, Madam Chair. Thank you, Representative Small, for being here. I'm glad you got your shot. My question was actually about the last resolve and the list of entities that the resolution will be sent to. And some of them obviously make sense. But I asked Katie McGlynn whether there was a standard list or if this was a sort of self, I don't know, a specialist, because there are, if it is a specialist, there are organizations or entities that I think are missing. So I was just wondering what your conversation in the House was about that. Absolutely. And wonderful question. And so something that I'll share about the work that we've done in committee around the resolution was really holding that this request in the language presented within the resolution came from community and more specifically in collaboration with the Racial Justice Alliance. So as you'll see, we passed the resolution as introduced and did not make edits to what was provided in there. So I think I would applaud expanding that list as to who would have access to this resolution, especially having it mailed to them. But we did not have explicit discussion as to who was included or not included on that list in committee. Okay. Great. Thanks. Thank you. Katie, I'm going to, I'm reaching out to a friend. Katie, correct me if I'm wrong, but once we have a resolution in place, we can just send it to others beside those listed. We can ask the secretary's office, for example, to send it out. I think we've done that in the past, but maybe this is not your question for you. This feels more like a parliamentary question, but I can reach out to Secretary Blumer perhaps and try to find an answer for you. That would be helpful or maybe clerk Rask also in the house. That would be okay. I will do that. All right. Good. So then you heard a conversation at the end when you when you got here, as we were listening to Dr. Levine about the resolve clauses and the extent to which they explain what we might take up in the future, sort of the roadmap going forward. So could you talk a little bit about the discussion your committee had about the resolve clauses relating to next actions, legislative work? Absolutely. I think a large part of this resolution that we held, dear, was that this is a first step in the recognition. And I think as we heard in testimony from Commissioner Levine and others, was this focus on that recognition is the most important piece, especially when it comes to accountability and the work that we're doing here in the legislature. So though it doesn't outline specific steps that we will be following, it is very broad yet narrow in understanding that the work that we need to do is really in policies and future work coming out of the legislature. And I think just talking to the work that we've done in human services this year over in the House has been while we've had this in the back of our mind as a resolution that we were taking up, it also added that equity lens into the work that we did and such things such as the child care bill and really understanding that the access for different communities to child care is important, especially the education that would go into it. So all of that to say, I do love the conversation and talking about specific steps in ways that we can show up and support community. But I also appreciate the broad swath and really understanding that as you were saying in comparing it to climate change, there are so many actions that need to be taken that we don't want to say that there is one path to eradicating racism within our systems and institutions. Thank you. Thank you. Questions for Representative Small? Senator Hooker. Thank you. Thank you, Representative Small, for joining us. I'm curious to know if you could cite some of the testimony that you had that was so convincing about the systemic, about systemic racism as it pertains to public health. I know that the vote in the House was awesome in that so many people supported the resolution, but why? What was it that was so convincing? I would say the largest convincing factor here was actually Commissioner Levine's testimony and really recognizing that the experts when it comes to public health within our state have already taken this action and are already seeing, especially in COVID, and I think that's the lens that I'll use here today, is recognizing that the declaration from the Department of Health came while we were in the midst of a statewide global pandemic. And so what we saw is when they made this declaration, they also made a health equity team that directly collaborated with community organizations and communities of color to understand where the barriers are. So we saw that come up in translation. We saw that come up in the piece of trusting a vaccine as we're talking about this today and understanding that for communities of color in particular, we have a history of testing on our communities rather than really promoting health and giving them access to a vaccine that is meant to protect their health rather than be a test subject of what would be going out to the rest of the community. I use the specific example there of Tuskegee and recognizing that we tested the effects of syphilis on human bodies by testing it on people of color in particular and then trying to diagnose or create a vaccine for the general body following that or medications, I should say. The other piece that really came up in testimony was hearing from Patricia Johnson, who is a registered nurse down in Bennington. And so she has done collaborative work with the NAACP as well as Southern Vermont Hospital and doing BIPOC, Black Indigenous People of Color, specific vaccination clinics. And one piece that was really resounding was her saying, I want to have my shot done publicly because I wanted to build trust within the community. I want to show them that community leaders were getting involved in this because prior to that, there wasn't this buy-in or trust in the systems again because of that history that was coming up. And then I think when we talked about the systems piece, it kind of got difficult because we focus a lot of this conversation on health care. But when we think of public health overall, we're thinking about access to, as Senator Lyons was saying, access to transportation and education and housing in the various ways that it shows up for our communities. But when we focus in on health care, what we heard were stories of racist remarks and epithets that were shouted at nurse Johnson and her work or even a story of how there was a patient who was aggressing towards her in a racist manner. And yet there were other patients who were coming to her defense in that moment. And so there was this juxtaposition of trying to protect her own identity while also protecting the person who was putting such harm onto her. And so all of that to say, there was a mixture of hearing from the professionals who are doing this work and promoting health equity, while also that ground experience from community members who are saying, we haven't solved it here in our state yet. And we see these movements and we're really excited about the movements that have happened during COVID in particular. But what we see in this resolution is a continuance of that work and making sure that this isn't just a point in time or a flash point, but instead a sustained commitment to understanding that we have centuries of work to get through when we talk about eradicating racism. Thank you. That was a great answer, I think. Senator Hooker, I thought it was a great answer as well. A lot of information. And I'm sorry we weren't able to hear that testimony, but you've done a good job in summarizing it. Thank you. Yes. And so and thanks for that reminder. We did suggest that committee members look at the testimony on the House Human Services webpage because obviously our committee shut down two or three weeks ago. So we're looking to get the testimony that we can and we appreciate it. And thank you for your comments. Any other questions for Representative Small? Okay. Okay. All right. I understand that Senator Brock has a meeting at one. So Senator, why don't you offer your testimony at this time and then we'll move on to Boer Yang. So go right ahead. Thank you. And thanks for being here. Thank you, Madam Chair. Let me just start by saying that I fully support the activities to deal with issues that we see in this resolution. And I have no opposition to the overactions that we propose to take here. It's very clear that racial disparities are significant. They're significant in Vermont. They're significant throughout our country. And there's no question that there is in fact racism in the United States and there's racism here in Vermont and we see it in a number of actions that have been documented over the years. And that's not what I am concerned about at all vis-à-vis the resolution. As much as anyone in this chamber, I know what racism is. I've been called the N-word on occasion. I have, you hear the jokes about being seated in the back of the bus. I've had to be seated in the back of the bus as a child traveling in the South. I remember one of my most vivid memories with the age of about 10 years old in a railroad station in Winston-Salem, North Carolina. I was thirsty and I saw a large, beautiful silver water fountain, aluminum water fountain. And I walked over to take a drink and my mother stopped me and she pointed to the sign over the water fountain that said white. She directed me to a water fountain that was nearby. The water fountain was yellow and cracked and rusted. And the sign over that water fountain said colored. That is systematic racism. I remember as a young army officer at Fort Dix, I wanted to rent an apartment in order to move out of the bachelor officer's quarters that were World War II wooden barracks buildings converted into rooms and it were filled with cold smoke because that's how the post was heated. And I couldn't find anybody in Elizabeth Town, Kentucky who would rent to me. That's systemic racism. I remember when being sent to Vietnam, I went on orders to go to the Saigon support command. And when I got in country, I was set up to the Central Highlands and the Central Coast because the officers who were waiting for me at Saigon support command, commanders there, found out I was black and didn't want me. That's systemic racism. Today is not 1950, 1960, or 1970. And as we look at the definition of systemic racism, it talks about laws or policies that result in adverse impact and adverse circumstances. I haven't seen any laws. I haven't seen any practices that I can at least document that do that. Now, some may do that theoretically in effect. But one of the concerns I have and the sole concern I have about this resolution is that it makes this accusatory statement about systemic racism, doesn't clearly define it. But as I define it and as I look at the variety of definitions, and it doesn't seem to be one common definition, it talks about laws and practices, a form of racism that is embedded through laws within society or an organization that can lead to issues such as discrimination in criminal justice, employment, housing, healthcare, et cetera. And the point is this, as we look at some of these statistics, and one of the problems about statistics, you know, we keep talking about data. And I see tons of data, but I don't see a lot of information. There was an old book written in the 1970s, it's called How to Lie with Statistics. And you can cherry pick, and you can take statistics of and in themselves and post them and publish them. But they don't give us a story unless we look at the story behind them. Why? And that's the question that I don't think we ask merely enough. If we see a disparity between how black people, BIPOC is a term I really hate frankly, but again, I've been called a lot of things over the years. You know, being colored was really good at one point in time. And I don't really care about that. But what I do see is that we're not getting behind those numbers to say, why is that the case? And if we make the assumption that the reason for those disparities is systemic racism, we stop asking the question. And that's why I object to using that term in this way, in this resolution. It makes us lazy. It makes us fail to go after the real causes of why something is the case. We can take, for example, the vaccination rate that Dr. Levy just talked about, in which it's substantially lower for black people than it is for white people. Well, if I took that solely as an evidence of systemic racism, I would probably also look at the fact that Republicans are much less likely to be vaccinated than Democrats. And I would assume that that's probably caused by systemic racism as well. And I could go into statistic after statistic like that. I could also talk about the statistics that have been left out, that black married couples in Vermont have an average income rate higher than whites. But we don't mention that. Because again, the overwhelming statistics are in the other direction. And we need to get to the bottom of those statistics. I'm in favor of doing that. So what I'm proposing to the committee to think about is take the accusatory wording out of this resolution and recognize that causation and correlation are not necessarily one in the same. And I've given you a proposed resolution in terms of just supporting changes that's on, I believe, the committee's website. I believe Levy has posted it. And all it does is it keeps the resolution essentially the same as it is, except it eliminates systemic racism. It eliminates inequities and talks about disparities and causes us to do the same thing that we propose to do in this resolution. But without the accusatory language and without drawing the conclusion that is not supported by evidence in the resolution. But that also goes in to add in terms of the actions that we take, not just eradicating systemic racism, delete the word systemic, eradicating racism throughout the state, but adding something I think is important, identifying systemic racism where and if it exists. And then going on from there. But what's most important in all of this is identifying the causes for these discrepancies and not drawing a conclusion and then acting on the conclusion in the absence of evidence to support it. And that's my resolution. And that's what I propose. Thank you, Madam Chair. I think you're muted. I am muted. Thank you. I get the t-shirt. Senator Cummings. I am not finding Senator Brock's proposal on the website. Try refreshing the page. I just posted it a couple of minutes ago. Thank you. Okay. So, Senator Brock, just the concern that you have is that systemic racism is a value... I'm trying to understand that you... It is a conclusion that has been drawn rather than something that is supported by the evidence of laws or specific practices or actions that lead to these conclusions. Okay. I'll try to understand that. Again, I go back to my climate change analogy where we see certain outcomes and data collected and or we have models. At one point we had, I remember, analyzing 24 different models that suggested that the industrial revolution was the beginning of our global warming. And yet there are a number of folks who disagreed with that. So, I'm trying to understand the relationship between data and conclusions. And I think that's what you're raising. The thing that if you have data, you've got to carry the data analysis to the next level. If you take it at face value, it becomes very easy to say, this is the cause. When that data is really a correlation, it is not necessarily reflective of the cause. Or you haven't analyzed the data to sufficient depth to ensure that you're getting the correct answer. For example, if you say that black people have certain kinds of health results in Vermont, then you have to ask, well, what kind of black people? Is there a difference between black people who have historically lived in Vermont or in the United States for centuries, or new Americans who have just come to Vermont? And would it be likely that those black people would have different results and different numbers? And until you carry the analysis to that level, similarly, when you talk about population differences, let's say criminal activity, and you compare white versus black in Vermont, if you don't take into account that the average age of a black person in Burlington, at least according to the stats I've seen is about 26 years of age, and that you tend to have much higher criminality among younger people, are those numbers and are those conclusions adjusted for age so that you can, in fact, compare the two populations on a more equitable to use that term basis? All right. Thank you. Any questions for Senator Brock? Okay. Thank you. Thank you, Senator. This is the beginning of a fun conversation. I think it's too bad we're not back at the State House. Thanks again, Madam Chair. Thank you. All right. We're going to move on committee and we have with us Dr. Avila. I'm going to ask, are you okay for a few minutes while Boer Yang provides her testimony? Of course, yes. Thank you. Thank you so much. All right. So Boer, thank you for being here and we look forward to your testimony. And you've heard some of the conversations so far, so maybe you can help us understand going forward. I will certainly try my best. I'm going to share my, Nellie, can I share my screen? You should be able to now, yes. Okay. Thanks. So I did a presentation in the, I did a presentation in the House that I want to kind of just go over real quick just so that there's some consistency here. And for those of you, so thank you for inviting me and for those of you who don't know me, my name is Boer and I'm the Executive Director of the Vermont Human Rights Commission, which is the state entity that enforces the anti-discrimination laws of the state, which includes state government, housing, and places of public accommodations, which is a very broad word because it also not only includes commercial facilities, but also hospitals and prisons and so forth. So I'm just, I know that we're short on time and I'm going to run through this slideshow pretty quickly so I can answer your questions. But so what is a public health emergency? What's a public health crisis? It's something that impedes individuals and communities from being healthy. And the experts have told us that there's never really been a time, not a single year, where the population of African descent has been sicker or died younger than whites. And we know that racism contributes to shorter life expectancy and poor overall health. There are many places that have already declared racism a public health crisis, obviously the city of Burlington, but more than 170 local and state leaders and public entities, the CDC declared racism a serious public health threat and there's a similar bill at the national level seeking to do the same thing that this resolution is trying to do as well. So declaring racism a public health emergency requires two fundamental beliefs. You have to believe that racism exists and you have to believe that racism is prevalent. And I want to kind of just talk a little bit about the definitions of racism because oftentimes when we think of racism, we are thinking about individual racism. This is referring to the an individual's racist assumptions or beliefs about certain groups of people about their behavior. It's a form of racial discrimination that stands from conscious and unconscious prejudice and it is connected to economic histories, socioeconomic histories and processes and it's also supported by systemic racism. So these things are interconnected. Systemic racism is really about inequalities that is rooted in system wide operation of society. It is about policies and practices and laws as well entrenched in established institutions and I appreciated what Senator Brock said about maybe there are no laws today or policies today that are overtly racist, but there have been in fact up until recently there have been and that those laws still have an impact on the disparities and the things that we're seeing today at the community level, at the government level, at almost any institutional level. And so we can actually easily point to a history of laws and policies that were overtly racist that we're still trying to deal with today. How do we know that systemic racism is real? Well, we have disparities and in fact I'm not even going to, because of the shortness of time, I won't go through all of the disparities that one is contained in the resolution already and Dr. Levine did a great job of discussing, but there are national as well as local data that tells us that black and brown people are dying at great rates compared to white people and there are so many different reasons for why that is happening. So I would, I will share this slideshow with you later, but basically this is the data that we already know to be true and the question is why does this data exist? And that's why it's also important to declare racism a public health issue. One of, I want to go through an example of how systemic racism, individual racism are all interconnected, because sometimes I think we have trouble understanding that connection and housing is a really great example of that. We know through testing in housing that discrimination in housing is prevalent and I'm not even talking about cockroaches or lead or being cost burden. I'm just talking about the denial of housing to people of color. Housing providers generally disfavor African American renters nationally and in Vermont, so these are stats from Vermont. Also renters of foreign origin, renters with children and renters with disabilities. In 44% of the test that was conducted by Vermont Legal Aid, housing providers demonstrated either preferential treatment or the housing provider events on unambiguous discrimination. National origin discrimination occurred at most frequently, 48% of the time. Discrimination was subtle with housing providers displaying polite and courteous demeanor. Housing providers shared information with white tester of U.S. origin about other available units within the tester's price range. If the unit was no longer available, but failed to share any information or should only information about units outside the tester's price range to subject testers. Housing providers were more likely to follow up with controlled testers, white testers, than subject testers, even when the subject testers called to share that they were still interested in the units. You have landlords and rental managers calling up white testers when there was no follow-up and you have subject testers calling for the follow-up and yet you have a withholding of information that is readily available. Many of the subject testers believed that the units had been rented and no discrimination had occurred when in fact the units were still available and were offered to controlled testers. Similarly, African-American subject testers were less likely to be told about other available units and were asked questions about household composition and their employment work more often than compared to the white controlled testers. Okay, so why is housing discrimination prevalent in Vermont? It is across the country. Well, to really understand that, we have to take a look back and connect the disparities that we see today with the laws that were overtly racist that were put into place that create those disparities and look at that connection. We know that there was integrated housing. White people and Black people had started to live in integrated neighborhoods but civilian public housing programs demolished those and they developed segregating housing. This was purposeful government intervention to create segregation in our country and this is documented and it is proven. Federal government subsidized suburban housing development on the condition that the homes be sold only to white people and that the deeds prohibited resale to white to Black people. So they created housing specifically for white people, subsidized that housing, and then said you can never sell this house to Black people in the future. And then there were specific zoning laws that were put into place that made Black parts of towns zoned for industrial plants and waste whereas that was not true of the white parts of town. Black neighborhoods then became known as slums. White people developed the belief that Black people did not care for their homes and communities and we see that still showing up today. We have real estate agents and rental housing providers showing fewer available homes to Black people than to any other group. The Fair Housing Act did not address past discrimination. So we passed a very comprehensive fair housing laws. This is no more discrimination. You can no longer red line. You can no longer favor white people over Black people. Right now anybody regardless of race or color can buy wherever they want and can rent wherever they want. That was the idea. So you can't point to a current day law that is overtly discriminatory. But yet we still see discrimination and disparities exist. Those homes that I talked about earlier that had restrictive covenants continued to be sold to white families for generations thereafter. And those homes increased substantially in value and equity. We know that one way people accumulate wealth is land ownership and employment and inheritances. And because of historical injustices they have put people of color specifically Black people at an economic disadvantage. So you can pass a comprehensive law like the Fair Housing Act. And yet you cannot necessarily, that passing that law cannot necessarily fix the discriminatory laws that were created and put into place that create the disparities that we see today. This is why Black income is approximately 60 percent of white income and yet wealth is significantly low. We're talking about five to seven percent compared to white wealth. Why? Why does it look this way in Vermont? Well in Vermont people rent and sell through word of mouth and home owners are still predominantly white and more affluent. That's what we mean about systemic racism. This isn't just about these landlords and these rental managers are racist either unconsciously or consciously. This is also about the fact that home owners are still predominantly white and more affluent. Affordable housing is scarce in Vermont. There's a tough competition for housing. People are more likely to tolerate discrimination and less likely to report housing discrimination for fear of losing their housing. We have an affordable housing crisis in Vermont that also contributes to the prevalence of discrimination. And the standard for proving housing discrimination is really high. We have a court system that is predominantly white and male. And so that again this is an example of systemic racism where you have homeowners who are predominantly white and more affluent. You have a court system that is predominantly white, more affluent, and male. And then you're looking at these disparities as of why does that exist. It's not just individual racism. It's because of these systemic systems in place and they're in place because we had very clearly over laws that were overly racist. And we're still dealing with that. The roadmap to eradicating racism looks like this. Right? This is the best picture I can show of chaos. It's like at the end of the day racism impacts our health. Poor housing, lead exposure, injury, poor schools. We know that high school graduation is a determinant of health. We know that women who have higher education, their children are more likely to live beyond their first year of life. There's a range of things from social determinants to health that really make a huge enormous difference. I ask you to consider thinking about racism like any other public health issue, like smoking, and the impact of declaring racism a public health issue. Because when we do that to smoking, we have shifted the way that we think about smoking. Today, we know how many people smoke because of bisects, race, gender, age. We know how many people have diseases and die from smoking. We know that the costs connected to smoking. I don't know if we know what the costs are connected to racism yet. We know we can test how effective our strategies are in addressing it. And again, these are a lot more statistics around smoking too. The key is that when we declare something a public health crisis, we actually make a commitment to addressing it and collecting the data around it. We cannot wait for the data to be collected first before we declare racism a public health crisis. That is putting something before you declare it, and that is what prompts the collection of data and the reporting of data and then the work. And that's what happened with smoking. When we declare racism a public health emergency, it recognizes the harm to people of color. It makes it the work of health advocates and health experts in addressing racial disparities in their field. In the same way that we demand teachers and principals and superintendents to be responsible for equity in schools, we have to demand health advocates and health experts to address racial disparities in their field. They're the most capable of doing that. It commits resources to collection, analysis, reporting, and ultimately eradicating discrimination. It informs the public and shifts culture and climate around issues of race. 30 years ago, smoking showed up in TV shows and commercials and was in bars today. I think most of us, even people who are still struggling with quitting smoking would find that it is a unhealthy behavior, one that is kind of shamed upon. And I would just ask us to sort of be looking at racism in the same way in terms of shifting culture and climate. And ultimately, the most important thing is where this is important because this is really ultimately about saving lives and recognizing that. So, thank you. Thank you. And will you send your slides along? Great. That would be terrific. Questions for Bo Yang? That was very helpful and greatly appreciated. It's difficult when we do have data. It does support systemic racism, but it isn't the end of the collection. Right. Yeah. Absolutely. Yes. In fact, I think Dr. Levine mentioned today that they only started to collect that information recently. That's right. They only started to take a health equity lens. And so I think it's really important to recognize that we're really far from that. And so we can't demand the data that is going to show that racism causes all of these disparities before we've declared it an issue to create the data collection in the first place, to prompt the data collection in the first place. So, thank you. Thank you. Thank you all so much for your time today. Really appreciate it. Terrific. So, committee, we're going to move on to Dr. Avila. And then I believe we have Mark Hughes here as well. So, Dr. Avila, thank you for being here and thank you for being patient. Why don't you introduce yourself for the record and then we'll hear your testimony. Yeah. Thank you, Madam Chair, for having me in this committee. And I want to need to share also my screen. Okay. Thank you. I'm happy to share. Yes. Yep. I just gave you that ability. Thank you so much. Okay. And I'm going to try to be brief as well. I provided a longer testimony in the House Health Care Committee a couple of weeks ago. And I also provided a testimony on health disparities in February 24th, which is a two-hour testimony around health disparities nationally and in Vermont. Before I get started, I want to share that I'm speaking today as a health disparities and health equity scholar. But my views are not necessarily those of the University of Vermont. So that's a disclaimer that we always had to give related to this work. I'm going to start with a couple of definitions and then I'm going to share a couple of examples of how systemic racism appears or is represented in practice in response to some of the comments that happened earlier in these testimonies. So let's look at a couple of definitions. This is a definition of health disparities by the World Health Organization and 20 and Healthy People 2010 and 2020. Health disparities are defined as unnecessary and they are avoidable. They are considered unfair and unjust. So let's pause here for a couple of seconds and break down this definition. If we say that health disparities are unnecessary and they are avoidable, what we are saying is that health disparities are preventable. There are many things that we can do to ensure disparities don't exist to begin with. And then once they take place, there are many best practice models to addressing and eliminating health disparities, which Commissioner Levine, Bohr just shared some of those examples. How do we address and eliminate some of these disparities? We also consider health disparities unfair and unjust because they disproportionately affect groups that have been historically disadvantaged in our society. So what is the definition of health equity, which is a very short, simple definition of everyone in our society having a fair and just opportunity to be as healthy as possible? And I would add to this definition, the definition from our own Health Commissioner Levine from 2018, where he expands this definition, especially focusing on communities that have experienced socioeconomic disadvantage, historical injustices, systemic inequalities based on social categories like race, ethnicity, social position, sexual orientation, and any other intersecting systems in our society. So let's look at racism as a public health emergency. And I would urge this committee and everybody who is looking at these topics to understand the reason racism is being defined as a public health emergency is because there is an urgent need to address systemic racism in our society as a whole, but also in our state of Vermont. And let's look at some of these examples and what's happening across the nation. And Borja shared some of these examples as well. The American Public Health Association last year specifically urged states, localities, cities across the country to declare racism as a public health crisis or emergency. And they specifically connected this emergency declaration of emergency to allocation of resources and strategic planning and strategic action. And I will talk about this in a few minutes from now. When we look at declaring systemic racism as a public health crisis, we need to look at what are the next steps in this emergency? What are the best practice models in addressing and eliminating and dismantling systemic racism and other forms of oppression from our society? So again, focusing on equitable allocation of resources and a strategic action, which I always highlight these aspects because we live in a society where there are many theories in place. There are many presentations on a regular basis, but the action takes much longer to happen, whether it's Vermont or whether it's at the national level. So this calls to action to have a strategic plan to address disparities and inequities and address systemic racism. So the American Public Health Association actually has a map online, which is an interactive map and there are more than 190 declarations related to racism as a public health crisis. And I encourage everybody to look at this map, look at the different cities and states across the nation. So this is to highlight that this is not just happening in Vermont, it's happening across the nation. And by declaring racism a public health emergency, we will be joining hundreds of other localities across the nation who also see systemic racism as a problem in our society. And this is one of the, there are many, all the declarations are available online. So you can click on the interactive map and you see the declarations. And this is one of the definitions from the city of Westerville in Ohio from a few months ago. They define racism as a social system of structuring and looking at assigning value based on social interpretation, which unfairly disadvantages specific individuals and communities. And one of the aspects of systemic racism is that the SAPs, the strengths of the whole society and leads to this waste of human resources and human sources that we have in our society. And also understanding that systemic racism leads to not being able to have so much talent wasted from our young people, young children who are racially diverse that end up incarcerating, for example, instead of ending up in college, they are suspended from school. So these are some of the issues that happen on a regular basis in our society that leads to wasting all this talent, which has long term negative effects for society as a whole. So this is a declaration from Barlington, which many of you are familiar. This is also the declaration that Commissioner Levine mentioned that he was one of the organizations that signed on to this declaration of racism as a public health crisis. And the Barlington Declaration was specifically linked to COVID-19 and how COVID-19 has resurfaced many racial disparities in our society, which is the next short part around this topic. Let's look at Vermont and COVID-19 racial and health disparities. For those of us who work in health equity, we define COVID-19 as the racism pandemic for the very undeniable and unquestionable reality that COVID-19 has resurfaced extensive and enormous racial disparities across the United States and in our own states. So let's look at some of these disparities from July 2020. Black Vermonters represent 1.4% of the state population, but they represented 14% of confirmed cases last summer. One in five cases were people of color. Black or African Americans represent the highest rate of COVID-19 followed by Asian and Hispanic Latino in the second white state in the country. So this is one of the aspects of an urgent need to look at systemic racism because how can we explain these disparities in the second white state in the country? We have similar statistics to states that are much more diverse across the nation. And one of the ways to explain what's happening in Vermont and across the nation is to understand the history of systemic structural and institutionalized racism across decades and centuries in our country. And if you look at this data, Commissioner Levin just presented some of this demographic information and disparities that we saw with COVID-19. And now we are at one in eight cases of people of color in Vermont are affected by COVID-19. And generally, this is something I always mention in my presentations as well, that in Vermont, we have a tendency to compare down instead of compare up. We, you know, so many so often I hear we're doing an amazing job with COVID and I see all the aspect that is not working. I see disparities in vaccination rates for BIPO communities. I see disparities in this proportionate number of children impacted by COVID-19. So it depends on which population we work with and how connected we are with the communities to understand the impact of COVID-19 and also systemic racism in our communities. And also to highlight that six, seven months ago, these rates were much higher. Today we're doing a bit better, but we can revert back into these numbers very quickly if we don't invest and allocate resources equitably to address and eventually eliminate health disparities. And let's, for example, look at vaccination rates for BIPOC Vermonters. Many of you know that Commissioner Levine mentioned that this difference of health disparities in vaccination rates for BIPOC went down to today. I think he mentioned 5.8 percent instead of seven, which is the most current data that we have available publicly. I do want to highlight that these gap narrow drastically and dramatically thanks to the work of BIPOC or community organizations. So I think we need to highlight that the work of BIPOC community leaders, community organizations that work directly with underserved community was that effort that led to narrowing these health disparities gaps in Vermont. And I work in pediatrics and I work in maternal and child health with children and families. And I do want to share this very alarming data from last summer because I shared it in every one of my presentations. As of last summer, there was a press conference where they shared that 3 percent of children had tested positive for COVID-19. And in the press conference, it was mentioned that only 3 percent of children had tested positive for COVID-19. As someone who works in maternal and child health, I hope that percentage would be zero for children. That would be our goal always to have zero for children. But then when we break down this data, we see that of that 3 percent of last summer of children 19 and under, 56 percent were children of color, and nine and under almost 70 percent were children of color. So it changes the conversation when we say only 3 percent of children when almost 70 percent of that only 3 percent happen to be children of color. And that's another way that we look at data to identify racial and health disparities during this pandemic. So these are some additional specific data that Commissioner Levin has already addressed in his presentation. And we've been talking about this for a long time already. We know that BIPOC Vermonters are more likely to be part of an outbreak, leaving multi-generational housing, have higher chronic health conditions or underlying conditions. What we also need to understand that underlying conditions are the direct result of exposure to poverty, redlining, gentrification, historical trauma, and most importantly, systemic institutionalized structural racism in our society. So for those of you who are familiar with my work, I've given several testimonies in the last few months, and I've also given many interviews about this topic. And I encourage everybody to look at some of the work that has been happening in Vermont related to addressing and eliminating health disparities. So finally, I do want to acknowledge the comment that was made about systemic racism and not having explicit laws or overt laws currently that say or having racist laws right now or racist language in laws and policies that the practice is very differently. And I can give you two very quick examples. I am a professor here in Vermont, yet I became a professor when I was 21 back in Argentina. And I was a professor in several universities back home, including the University of Buenos Aires, Universidad de Buenos Aires, which is one of the top 30 universities in the world. When I came to Vermont, my teaching experience was not recognized. And there is no law or policy that says we don't recognize experience from Argentina is the practice of systemic racism that leads to institutionalized issues and structural issues and putting community members at a disadvantage. And another quick example, also a personal example, there is an article from 2018 from the Migration Policy Institute that looks at hiring immigrant healthcare workers in the United States. And they found that if you are a healthcare worker from South America, you have six times or six times less likely to be hired compared to other countries across the world. So that's how practices happen in our society. We have, for example, many former refugees in our area who were physicians, nurses, but back home, and they cannot practice in the United States. And I always mention this in my presentation because we have a shortage of physicians, a shortage of nurses. And I have my sister who is a registered nurse. She's been waiting for her accreditation to be recognized in Vermont for over a year and a half. So this is how the practice of systemic racism happens in our society. We have a struggle. We have a shortage. We have a qualified, talented workforce. And that doesn't take place in an effective way, which is how it happens in practice for specific community members that come from specific countries or specific national origin. So finally, I want to close with what needs to be done. What are the best practice models to understanding how to address health disparities? One thing I always mention in my presentation is that we need to be proactive. And suddenly, we live in a society where we are reactive. Something happens like COVID-19, and now we're trying to declare a public health emergency, which should have happened a long time ago. We need to improve data collection systems. Every other testimony I heard today talked about data collection systems. We need to understand in Vermont, BIPOC communities, more than 50% of BIPOC community members are members of immigrant communities or refugee communities. So race and ethnicity is one aspect of data collection. We also need to have national origin, spoken and written languages, and other aspects of demographics to be able to identify health disparities. We need to provide ongoing education and training about systemic racism and the history of racial disparities in the United States and Vermont. I always share, I was not born in the United States, yet I spent my career of 20 years in Vermont teaching U.S. born people about the history of the United States. So that aspect of learning and understanding the history of systemic racism and the impact it has in today's disparities. We need to diversify the workforce. And this is another example of systemic racism in practice. How is it possible that the majority of doctors, the majority of nurses, the majority of teachers are white in Vermont? And sometimes people say, well, Vermont is a white state, but that's not necessarily correct because there are many areas where, look at Winooski, Burlington, 25% racially diverse, 30% racially diverse. We need to ensure that the workforce reflects the populations that we serve. And for many disciplines, we do national searches. So that's another aspect of the world that we need to ensure that we reflect the demographics of the population we serve. We need to institutionalize cultural knowledge. We need to work with communities and not in communities like it has happened for so long in Vermont and nationally. And every other testimony that happened today talked about these issues. And we need to allocate resources equitably to address disparities, funding, community health workers, cultural brokering programs, organizations and programs that have a mission and vision to eradicate and dismantle systemic racism. And finally, I'm going to leave you with a quote from our own governor, Phil Scott. And this was one of his responses to the racist comments that happened related to the BIPOC vaccination clinics. And he explained that the legacy of racism in America and in Vermont still drives a lot of anger and fear. And it is evidence that many Americans and many Vermonters still have a lot to learn about the impact of racism in our country and how it has influenced public policy over the years. I wholeheartedly agree with our governor and with this quote about the work that we need to do and consequently declare in racism as a public health emergency is one step forward in dismantling systemic structural institutionalized racism and eventually hopefully addressing health disparities. So thank you again for the opportunity to share this testimony. And I have, if people have any questions, I'm happy to answer those. Thank you, Dr. Avila. That was very rich and we very much appreciate it. And if you could please send your slides to Nellie, then we'll have them on our webpage for reference. Thank you. It's great. I'm going to ask if there is a question. I think probably we're going to have to move on. Senator Hardy, quick question, please. Yeah, I have a few questions, but I will just keep it to one for now. But could you explain a little bit more about that? I might have written this down backwards. So I'm just, I would love for you to explain a little more that we compare down rather than compare up and just reiterate what you mean by that, because I thought that was an interesting concept. Absolutely. And this is something, thank you for that question, Senator Hardy, because this is something I mentioned in all workshops and presentations I do, that in Vermont, for example, we tend that we have a tendency to say, we have some of the best public school systems in the country. We're doing an amazing job with COVID-19. But the comparison is with states that are not doing a good job. And what I would urge Vermont to do is to compare up, look at countries, other countries in the world that are doing a better job, look at school systems across the world that are doing a better job, look at every type of system, whether it's public safety, whether it's healthcare, look at national healthcare systems that are doing better in other worlds, and they don't have the health disparities that we do. So we need to start comparing up and not down, because if we compare down, we're always going to look great. And then if people think that we're doing a great job, then what do we need to do to address these parties and inequities? So there is that conversation that people look at the charts and say, we're doing amazing, so we don't have much to do. But there is so much more to do to ensure that we increase life expectancy. We are like number 43 compared to other countries in the world, and we are one of the richest countries in the world. So those are staggering statistics. We have the second highest child poverty rate in the world. That's unacceptable for me working in this field, considering the United States is one of the richest countries in the world. So we need to compare again up incarceration rates, highest incarceration rate in the world. How is that possible? Why is it happening? What are the structural systemic issues that are causing these disparities? Of course, we're doing better than other states in southern United States, but we can continue to compare down. We need to compare up and do a much better job. But thank you for that Weston. Okay. Thank you. Thank you for the explanation. That was really clear. I appreciate it. And just one comment. I was sorry to hear that your sister's having a hard time with her nursing license. I thought we passed a law a couple of years ago to make it easier for people from other countries to transfer their licenses to Vermont. So I would be happy to look into that for you and see why that might be happening because I don't think it should be, but I could be remembering wrong also. So thanks for mentioning that. And thanks for your testimony. Thank you very much. Thank you. You've said a lot of things that have triggered lots of ideas and we greatly appreciate it. And I'm sure we'll see you again. All right. Yes, thank you. Mark Hughes is here from the, I think it's Mark. Yep. From the Vermont racial justice alliance. Thank you for being here, Mark. Why don't you just please introduce yourself and we look forward to your testimony. Just folks know that we are going to have a hard stop with testimony in about 10 minutes just because we need to have some closure to our committee work. So Mark, thank you for being here. Thank you, Madam Chair. It is good to see you again. And I am Mark Hughes. I am the executive director of the racial justice alliance as well as justice for all. If I could have an opportunity to share my screen with you. I do have a couple slides that I'll speak to. Racial justice alliance has been around for a couple years, justice for all since 2014. Many of you have had the opportunity to be in front of and testimony previously. Just set this screen up here and I'll come to you. And hopefully, I won't have the challenges that Dr. Levine had this afternoon. And I just would ask the committee if they have the ability to see the slide that's before you, Madam Chair. Madam Chair, do you see the slide? We can see it. Thank you. Yep. It's good. You have all the slides on the left. You don't have the slideshow. That's fine. But we can read it. That's fine. We can definitely read it. So we'll keep it in this way, in this manner, because the slideshow presentation, it fails to render. I just wanted to be clear on where we're coming from in the position and how we arrived where we are. We are here as the racial justice alliance to secure sustainable power, to ensure agency and to provide security for American descendants of slavery. This is our mission statement while embracing their history and preserving their culture. And I just wanted to take a brief moment before I went further, since there was some definition surrounding systemic racism. This one is from Joe Faggin and Kimberly Ducey's book Racist America, Roots, Current Realities and Future Reparations. It says here that systemic racism includes the complex array of anti-black practices, the unjustly gained political economic power of whites, the continuing economic and other resource inequalities along racial lines. And the white racist ideologies and attitudes created to maintain and rationalize white privilege and power. Systemic racism here means the core racist realities are manifested in each of society's major parts. Basically, if it exists anywhere, it exists everywhere. Well, what I'll speak to just briefly is about this little diagram that I have here. And what it depicts is what I've surrounded American descendants of slavery, this is what we refer to as determinants. I'll tell you a little bit about our wellness working group and the work that we've been doing and how we've interfaced with other entities and I'll tell you more about the work. But what this slide accentuates is that systemic racism is informing every single one of those determinants and every single one of those determinants with empirical data consistently produce disparate outcomes that impact American descendants of slaves consistently, continuously, and they're being exacerbated right now by COVID-19. There are a lot of numbers that we can talk about. I have my data person on stand by Patrick. Patrick has been doing data for the racial justice alliance. He may not get a chance to speak to you, but he did come in case there were some specific questions that I couldn't get after. We've been aggressively collecting racially disaggregated data across all systems of state government, which has been informing our work. We've been doing that continuously. We continue to do that. I encourage you to go to our website and look at our data page where there's a representation of not just the data that you see within the policy that's in front of you, but also all of the other policies that we've submitted and much of that data that's out there on that site. That's vtracialjusticealliance.org. Data is really not even reflected in many of our policies, but it does do one thing consistently and that is to illustrate the disparities, racial disparities across all systems of state government. We've got a few priorities. Some of them involve our true history. This is the heart of systemic racism. Until we can embrace our true history as a nation, we really can't have this conversation. Whether it's the 1619 story or whether it's the 1865 story, we have to establish a contiguous line across our history as a state and have conversations, real conversations about our history. We're looking at areas of ownership, wellness, economic empowerment, changing systems and moving money. Then of course, we're also looking at the whole conversation surrounding the relief, the COVID relief. One of the things that I think is important to start with is at the top of this session, you all saw this. Every legislator, every 180 folks in the building saw our plan to dismantle systemic racism. We called this act, acknowledge, create and transform. It started with a constitutional amendment. You move that. Thank you, Senate. You move that. We also had a resolution to clear systemic racism in other initiative policy initiatives ranging from the reparations bill which returned this session. There is business empowerment. There's land and home ownership policy that we put forward, cultural empowerment. You've seen the health wellness bill because it came across in 210. Thank you. But this is a set of policies that was specifically framed to address the dismantling of systemic racism. The one that's in front of you, JRH 6, is just framing this conversation. Moving on, I just give you just a brief overview of what we're doing here. Yes, we do have a board of directors. They're all black folks. We're here in Vermont. There's a steering committee that is a people of color steering committee. We have multiple working groups here. One of them is what we refer to as a working group on wellness. Wellness has been a pretty serious point of focus for us. What we say is that our wellness is at the epicenter of all what we do, everything we experience, we must consider every action taken to dismantle systemic racism as an act of enhancing our wellness. We'll disrupt status quo systems and develop long range strategies for black lead alternative approaches to create healthy outcomes for black folks. We're fighting for wellness as if our lives depend upon it because they do. So these are some of the things that we're doing in terms of structure. Of course, there's organizations, committees, and so forth. The wellness working group is an integral component of what we're doing here at the Alliance. This is kind of a high level definition of what they do. They meet every other week. That work is ongoing, but I think the two main things to focus on here is the disruptive initiatives. That is, what are some of the things that we're doing right now, whether it's our participation in the establishment and the cooperation with our partner organizations, with the operation of BIPOC COVID clinics, yes, or those information sessions, or this work here, or perhaps even a one-on-one peer-to-peer counseling, or creating other strategic initiatives that might even involve various activities of affinity groups and so forth. Then what is our long-term strategy, which we're in partnership with the Vermont Health Department in creating in terms of what we do to address wellness. Not wellness just from a clinical perspective, but also taking into account that every single one of these areas of social determinants ranging from economics, all the way through health services delivery, through housing and land ownership, and so forth, that they must be all addressed. So, yes, some of the activities that are underway, we've got a lot of things happening. Right now, we are in the heartbeat of ACT. This is the resolution. Operation Phoenix Rises in play here in the city of Burlington. There's a lot of other activities that are happening. Again, I wanted to frame what we're doing in terms of with this resolution as it not just being some kind of one-off that just came out of left field and somehow just ended up here at the end of the session, and we're just kind of back here just making up stuff as we're going along. This is a congruent component of all of the work that the Racial Justice Alliance has been doing. It's not by any mistake. It's why we initiated the racism is a public health emergency resolution here in the city of Vermont. Yes, we definitely stood at the forefront doing that. Myself, Mayor Murrow Weinberger, Bob Bick of the Howard Center, Jesse Bridges, as well as Dr. Leffler spun up a group of 30 organizations here, and I think that that's really important. You can end that presentation now. I'm just going to conclude with a couple of other things. To get into is that, first and foremost, there are three components that happened here. One was a resolution. The other, from that resolution, there became a commitment from the city and our other primary stakeholders, and what happened was there was a communication that went out to folks saying, hey, would you like to support this? And various organizations chimed in. Now, I just want to take you back to some language here in the resolution that's before you. What it says is what's resolved is in addition to it being a health emergency, it's saying that you, the legislature, that you're committing to a sustained and deep work of eradicating systemic racism throughout the state, actively fighting racist practices and participating in the creation of a more just and equitable system. It says that the legislature, you, that you would commit to coordinating work and participating in ongoing action, grounding in science and data to eliminate race-based health disparities in eradicating systemic racism. So what we are asking for is your leadership with this resolution. We're asking for your commitment. We're asking for your leadership. It is unfortunate that we are in the last week of the legislative session talking about racism as a public health emergency and a resolution. It is unfortunate that 45 or 46 policymakers in the other chamber refused to suspend the rules to get this to you in a more urgent manner. It is unfortunate that you have to come back in and open your committee, but we're grateful that you reopened your committee, Madam Chair, because we see that you saw that this was an emergency. So we thank you for that. What we did as the alliances, we also put forward some general guidance to what we call a public action advisory from the Racial Justice Alliance to all of our partners here in the community, giving them some high level oversight or high level insight into perhaps some of the things that organizations, businesses, and agencies can do in order to respond. What I have here in front of me is over 30 organizations ranging from folks like Kim Fitzgerald, Taisha Green, Brenda Thorpey, Charlie Baker, Jeffrey McKee, Sarah George, Josh Miller, Nancy Owens, Tom Torty, Karen Yackels, Christine Hughes, Kate Log, Joey Bergstein, Mark Redmond, and many, many, many, many others who signed onto this commitment. And many of them have, in addition to signing on commitments, made lists of things that they would do in response, as Dr. Levine had indicated. I'm almost done. And I think that, you know, it's important to note, you know, in addition to the city and Howard Center, the United Way University of Vermont Medical Center at Burlington Housing Authority, I'll pause there because it was only as a result of the resolution that these folks stood up, stepped forward, and committed to begin to do the work that is transformational in our community here. I'd like to see the same thing in Hardwick, the upper valley, the lower valley. I'd love to see it happening up in Franklin, where my brother resides, and other places across the state. I think we can do it with your leadership. Here are a couple of things that came from some of the commitments that these folks made. The city of Burlington said, we're going to hire a public health manager. She's in place. They also said they're going to deploy a million dollars to this effort. They did it. The Howard Center said, we're going to create a data dashboard. We're going to advance recruitment strategies. And the list goes on. The United Way said racial equity is a foundational principle in our community investments. University of Vermont Medical Center said, we're going to collect data from across clinical areas. And Burlington Housing Authority said, we're going to reexamine the housing, the HUD, and other housing regulations. The Boys and Girls Club provided BIPOC club members with academic and financial support for higher education. All as a result of the resolution that we passed, declaring that racism was a public health emergency in Burlington. So this is an opportunity. So I just wanted to speak briefly and in closing, just speaking towards this whole idea of wellness, the working group, and the data team. So this is an apparatus that is in full motion, the Racial Justice Alliance. What we put before you, we think is well thought out. We think it's strategic. We think it's well positioned. And we think that it will create change. Is that quantifiable? No. We had no way of telling what was going to happen from what we did here in Burlington. Will there be something that comes of it? We believe that there will. So in closing, I would just urge the committee to pass the resolution as it is. I would offer up just as we've done here in the Chittenden County, the Racial Justice Alliance, we stand behind the work that we continue to do. We stand in support. We stand at the ready to support the legislators. The legislators, rather, in this work, we will continue to do so. It is the reason why we've asked for a copy of this resolution because we sent it to you. We'd like you to send it back. And as far as the things that are next in this endeavor is... Mark, I know that you have a lot to say in conclusion. So I'm going to ask you, we have one other person who is waiting to speak briefly. And if you could come to closure, that would be helpful. Absolutely, Madam Chair. So I would say that this work is important, but it is also... It's incredibly important that we get it done now. If we can't do it now, then I don't know when we'll be able to do it, given the climate that we're actually working in. Madam Chair, I thank you for the time this afternoon. And I stand by for any questions that you might have. Thank you. And please, if you don't mind sending along your slides to Nellie so we can post them and have them available. They are very informative. Thank you. We appreciate the time that you've taken to put this together for us very much. And before we go to questions, I am going to ask Joanne Crawford. You are here and you had asked to speak today. I think we have your testimony, which we can post. So if you don't mind to please... Is it... It is Joanne. For a minute, I thought it was Jean, but it's Joanne. So please, just we have one minute left, but we're going to go probably go over by about five minutes. So if you don't mind, please go right ahead. Okay. Thank you. Thank you for allowing me to provide testimony today. I'm speaking on behalf of myself as a member of the Abnaqui community. And I would just like to say I would like to see information about the native community, the Abnaqui and Native American community in this resolution. It is a resolution relating to the racism as a public health emergency. And for us to be missing from the resolution is concerning to me. And we are also in one of the whereas statements. We are actually lumped into an other category, which is basically making us invisible and our... And just our data and our statistics invisible. And I think it's really important that you take a look at some of the barriers that the Abnaqui and Native American community face because they are substantial. And we have... The attempts of erasure of our community have been constant over 100 years and still are happening. And when we are left out of resolutions like this, I think it is very harmful. And so I have provided some data in my written testimony and you can see that. And if you have any questions, that's it for me. And thank you so much for allowing me to be here today. And I do support this resolution. Good. Thank you. And just so you know that with each whereas clause, there is a link to data that you might find helpful because it does reference Vermont ethnic minorities, including Abnaqui, within the Department of Health. So we will look at that. But obviously your concern is significant. And we've known about this for a number of years. So once we sign on to the resolution, we are also signing on to evaluate our policies and our relationship with all communities who are in a... Have health disparities. So thank you. Yeah. Thank you. And I can I just say one more thing is something that has affected the Abnaqui community substantially is the fact that we're not well represented in the data, simply because so many of our community are afraid to identify as Native Americans. Yes. Yes. And I'm familiar with that. I'm very close to someone who has worked closely with Native American populations, both in this state and in Alaska and Vancouver and other places. So I understand what you're saying. And I do understand that there are health disparities associated with these populations. Thank you. Thank you. Committee, I think we're over time. But if there is a question from our queues at this point, okay, I think we're good then. So committee, I have asked Nellie to set up a meeting tomorrow morning at nine o'clock. I do not know anyone's schedule. Is that possible? We need to have a conversation about this resolution. Okay. Yes. I can go until three o'clock today. But tomorrow morning, I'm trying to I know natural. No, economic development is meeting. And I'm trying to get a time because I'm losing my lawyer this afternoon to get the broadband bill out. And we're looking at nine o'clock tomorrow. All right. It's not set yet. But okay, well, I'm running out of time. Yes, I am also I can meet until two 30. So with that, so why don't we do that? Why don't we, Nellie, how does that work with our zoom environment? I think that should work fine. Okay, that's good. What I'm going to suggest is a two minute break, a stand up break. Everyone, please just take that time. And then at 206, we'll be back here