The Vermont Department of Health has tried something new while gathering health data for adults across the state: special outreach to people who identify as Black, Indigenous or people of color, or BIPOC.
That’s part of the state’s overall recent efforts to more accurately understand the health needs of Vermont’s entire population. BIPOC communities, for example, are often underrepresented in datasets.
And while the health department said its extra outreach, called an “oversample,” was successful in recruiting more survey responses from BIPOC Vermonters, it’s not without complication.
The department doesn’t plan to do this oversampling again in the future, in part because of recent federal funding cuts. And specifically for Vermont’s Indigenous population, there are nuances of belonging — and recognition — that are difficult to navigate.
The oversample
The Health Department performed its oversample as part of the Behavioral Risk Factor Health Surveillance System — an annual survey that uses randomly selected telephone numbers.
For the phone numbers that belonged to BIPOC Vermonters, those people received a letter ahead of time, answered an online version of the survey, and received a $10 gift card in return.
According to the department, this added more than 300 extra survey responses from BIPOC Vermonters. Those are reflected in the most recent survey report, published last month. It summarizes data from 2023, collected from over 9,000 respondents.
“That oversample gives us a much, much better picture and more actionable data,” said interim Health Commissioner Julie Arel this week.
While the latest survey data shows most of the Vermont adult population reporting good health, there are disparities.
Overall, 8% of Vermonters said they didn’t get medical care because of cost in the prior year, and people with less education or lower income, BIPOC adults, LGBTQ+ adults and people with a disability were more likely to delay care. Those same populations were also more likely to report their community was not safe for walking.
Adults with disabilities were five times more likely than adults without disabilities to experience physical symptoms like headache, upset stomach, tensing muscles or a pounding heart due to how someone treated them based on race. And BIPOC adults were four times more likely than white, non-Hispanic adults to experience these symptoms.
“It’s when we start to dig in — and see where the disparities are — that it shows where we really need to do more work,” Arel said.
That work, however, is not likely to include more oversamples. According to the Health Department, this is for a couple reasons. For one, the federal government just took back $7 million from the department, money that was largely allocated toward health equity efforts.
The other reason the department said it won’t do more oversamples is that BIPOC Vermonters make up about 10% of the state’s adults, and run the risk of being over-surveyed.
Indigenous communities in Vermont
Indigenous Vermonters are a population the Health Department has paid particular attention to. A June 2024 statewide health equity report indicates some significant disparities for the state’s American Indian or Alaska Native population, based on 2021 and 2022 survey data.
(Nationwide, Indigenous peoples face barriers to health rooted in historical and contemporary discrimination.)
The Vermont Commission on Native American Affairs recently examined the numbers.
“I found it to be somewhat startling,” said commission Administrative Director Breanna Sheehan at a meeting in March.
She presented a slide that showed higher rates of cancer among the American Indian or Alaska Native population — 33%, compared to 21% for Vermont overall.
Other slides showed American Indian or Alaska Native adults and youth had a higher likelihood of disability; nearly half of youth respondents reported poor mental health most or all of the time; and a comparatively large percentage of adults had cardiovascular disease.
Sheehan also noted that the survey relied on people self-identifying as American Indian or Alaska Native.
“Keep in mind, folks, that means it’s going to be undercounted,” said Commissioner Jeff Benay.
It’s common for Indigenous peoples — particularly those living on reservations — to be undercounted in datasets like the U.S. Census, which also relies on self-reporting.
However, a recent paper from the Indigenous think tank Yellowhead Institute points out a different concern with research relying on self-identification: People can claim to belong to an Indigenous nation when they in fact do not.
“The data collection becomes precarious because there can be a mix of genuine and inauthentic individuals participating in the research studies,” the paper reads. “We cannot build accurate or effective models for action or change if they are based on fabrication, distortion, or misrepresentation.”
For years, two Abenaki First Nations have denounced the four groups recognized by Vermont as Abenaki tribes, saying the groups have failed to provide adequate evidence of Abenaki ancestry and kinship ties.
State-recognized tribes have continued to deny these claims, saying they are under an unfair amount of scrutiny, and that they have provided proof of their Abenaki descendancy and connection, albeit not publicly.
There is no way to confirm who makes up the self-reported American Indian or Alaska Native respondents in the Vermont Department of Health’s data — the survey doesn’t require tribal affiliation for respondents.
The Health Department has begun working with state-recognized tribes and affiliated groups as it tries to understand the needs of Indigenous Vermonters.
Song Nguyen, the department’s director of health equity, said she was aware of the dispute between the Abenaki First Nations and the Vermont state-recognized tribes, and called it “really challenging and very complex.”
“At the end of the day, we trust that individuals that are providing us with information are who they say they are,” she said.
Vermont Public reached out to leaders of local Indigenous communities — outside of state-recognized tribes the department is already in touch with — including at the University of Vermont and Dartmouth College, as well as Odanak First Nation, which has 16 Abenaki citizens living in the state.
None of them had been in contact with the Health Department, though most expressed an interest in hearing from state officials.
“I would definitely appreciate outreach,” said Adria Brown. She’s the director of the Native American Program at Dartmouth and manages a council that includes Indigenous faculty, staff and graduate students who live in both Vermont and New Hampshire. “I would generally speak to the need for culturally-informed care, training and treatment in particular.”
Nguyen, the director of health equity for the Health Department, welcomed anyone to get in touch with her.
“At the end of the day, we really, truly want to do our best to serve communities across the state,” she said. “Specifically, those that are disproportionately impacted by health disparities.”
Lexi Krupp contributed reporting to this story.
