Vermont consistently ranks as one of the healthiest states in the country. In part, state health officials say, that’s because of social determinants such as a high rate of high school graduation, higher median household income, less violent crime, low unemployment, access to primary care providers, extensive health care coverage and other factors. But, they emphasize, it’s also due to Vermont’s longtime focus on improving public health.
That track record becomes clear when perusing the Healthy Vermonters 2020 State Health Assessment Plan, which highlights how well the state does compared with the rest of the country on community health issues ranging from alcohol and drug use to heart disease and stroke. It sets nearly 130 health goals identified by state government, health, health care and human services professionals, and the public.
On a number of health issues, the state clearly comes out ahead, although Healthy Vermonters notes there is still work to be done.
Here are examples of five preventative health measures succeeding in Vermont:
Reducing Teen Smoking
Vermont has made great strides in curbing tobacco use among teens. Thirty-three percent of teens smoked in 1999. More than a decade later, that dropped to 13 percent, below the 18 percent for American teens overall. Healthy Vermonters would like to go even further, reducing that to 10 percent.
The state has enacted a number of policies and practices to curb smoking among adults and impressionable children and teens, including:
- Banning smoking in numerous public areas, including workplaces, restaurants, bars, public transportation, daycares, and prisons and correctional facilities.
- Increasing the cigarette tax.
- Starting the Youth Access Quit Line.
- Running anti-smoking advertising campaigns, including those aimed at children and teens.
Vermont has reason to focus on teens; three-quarters of American who started smoking as teens will smoke in adulthood, according to the U.S. surgeon general. And many of them find it hard to quit later on. Among those who keep smoking, one-third will die 13 years sooner than non-smokers.
“Tobacco is still the leading cause of preventable death,” according to Healthy Vermonters. “Smoking leads to or complicates asthma, heart disease, cancer, lung diseases, stroke, low birth weight in babies, and infant mortality.”
Increasing ‘Exclusive’ Breastfeeding
Vermont is a leader in supporting and promoting breastfeeding:
- 86 percent of Vermont mothers breastfeed their babies at birth, compared with 75 percent nationwide.
- 58 percent of Vermonters continue to breastfeed when their babies turn six months old versus 43 percent nationwide.
- 40 percent of Vermonters are still breastfeeding when their babies turn 1 year old versus 22 percent of Americans overall.
The state also fares well with “exclusive” breastfeeding, in which a baby only receives a mother’s breast milk, not any other food or drink, unless medically necessary. The American Academy of Pediatrics recommends that babies receive only breast milk until six months of age, and breast milk plus solid food from six to 12 months and beyond.
In Vermont, 22 percent of mothers choose to exclusively breastfeed their babies in the first six months versus 14 percent of mothers nationwide.
“Scientific evidence is clear that breastfeeding for the first six months of life helps prevent obesity and Type 2 diabetes,” Healthy Vermonters states. “Breastfeeding mothers are also at lower risk of breast and ovarian cancer, diabetes, hypertension and cardiovascular disease.”
According to the World Health Organization, breast milk offers all the vitamins and nutrients that babies need and promotes their sensory and cognitive development while protecting them against infectious and chronic diseases.
Due to the overwhelming health benefits for mothers and babies, the Vermont report recommends increasing the percentage of mothers who exclusively breastfeed their babies in their first six months to 40 percent by 2020.
Among the Vermont initiatives to support breastfeeding mothers:
- The 10 Steps Project, which assists hospitals in helping mothers successfully breastfeed.
- Laws to support breastfeeding in public and in the workplace.
- Assistance for businesses to support breastfeeding employees.
Increasing Exercise Among Adults
Healthy Vermonters makes it clear that adult Vermonters are more physically active than most adult Americans. Fifty-nine percent of adult Vermonters meet physical activity guidelines versus 49 percent in the United States overall. The report defines physical activity as “any body movement that speeds up your heart beat and makes you breathe harder.” The report would like to see this increased to 65 percent by 2020.
And even though 17 percent of adult Vermonters don’t get any exercise during their leisure time, that’s still better than the 24 percent of all adult Americans who are couch potatoes. Healthy Vermonters suggests reducing the Vermont percentage to 15 percent by 2020.
“Regular physical activity is one of the best things you can do for your health,” the report explains. “It helps build and maintain bones and muscles, control weight, improve your strength and endurance, and makes you feel better, both physically and mentally.”
According to the report, each week adults need:
- At least 150 minutes of moderate intensity physical activity (e.g., brisk walking for 30 minutes, five days a week) or at least 75 minutes of vigorous intensity activity (15 minutes, five days a week).
- Muscle-strengthening activities two or more days.
There is a direct relationship between lack of physical activity and chronic diseases and unhealthy habits, including:
- Heart disease and stroke
- Mental illness
The state Department of Health’s “Get Moving Vermont!” website offers tips on goal-setting, making an exercise plan, overcoming barriers, staying motivated and keeping safe.
Increasing Sexually Active Teens’ Use of Contraception
Vermont teens who are sexually active are playing it safe by using birth control. Eighty-six percent of ninth through 12th graders who are sexually active reported using contraception versus 71 percent in the United States overall. Healthy Vermonters would like to see that increased to 95 percent by 2020.
On the other hand, how many teen Vermonters abstain from sex? The report notes:
- 81 percent of ninth graders
- 66 percent of 10th graders
- 51 percent of 11th graders
- 39 percent of 12th graders
For sexually active teens, however, contraception is key to keeping them healthy. For instance, the percentage of chlamydia infections in sexually active Vermont teen girls is fairly low, compared with the rest of the United States. Among females ages 15 to 24, 1.6 percent of Vermonters became infected with chlamydia versus 7.4 percent of Americans. Healthy Vermonters would like to see this percentage reduced to 1 percent by 2020. Chlamydia is a “silent” disease that can lead to pelvic inflammatory disease and infertility. In Vermont, only 25 percent of the estimated 5,000 people who are infected seek diagnosis and treatment.
In addition, Vermont’s teen pregnancy rate has dropped dramatically since 2000, when 20 out of 1,000 15- to 17-year-olds got pregnant, to 10.4 a decade later. That’s stellar compared to the United States overall, where the rate is 29.4, according to the U.S. Centers for Disease Control (CDC).
The CDC continues to view teen pregnancy as one of its “top six priorities, a ‘winnable battle’ in public health, and of paramount importance to health and quality of life for our youth.”
Teen pregnancy leads to greater societal problems, including:
- Increased dropout rates, lower school achievement and lower incomes among teen mothers.
- Increased health care, foster care and incarceration rates, and lower educational achievement and dropout rates, among the children of teen mothers. In addition, those children are likely to become teen parents one day and to be unemployed as young adults.
- Increased cost to taxpayers: at least $9.4 billion annually.
“Reproductive health education in schools can empower teens to make informed decisions about abstinence, sexual activity, contraception and protection,” Healthy Vermonters says. “Teens who have complete information and who are aware of their choices are better equipped to avoid pregnancy and sexually transmitted diseases, and have a better basis for healthy lifestyles and relationships as they enter adulthood.”
Increasing screening for breast and colon cancer
Cancer is the leading cause of death in Vermont, with more than 3,500 Vermonters diagnosed each year and 1,200 who die. The most common forms of cancer in women are breast (29 percent), lung (15 percent) and colon (8 percent); in men, prostate (27 percent), lung (14 percent) and colon (8 percent).
Yet there are many screening tests that can catch cancer early and help people survive. In Vermont, it’s clear that many adults are getting the message from health care providers about the need for screening. In two particular areas – breast cancer and colon cancer – Vermonters have done better at seeking screening than Americans overall.
- Breast cancer: In Vermont, 83 percent of women ages 50 to 74 have been screened for breast cancer versus 80 percent of American women overall. The report sets a goal of 95 percent. Current CDC guidelines recommend mammograms every two years for those ages 50 to 74. Each year in Vermont, about 500 women are diagnosed with breast cancer, and about 80 die. “Mammography, combined with a clinical breast exam, is still the most effective means of early detection,” the report notes. “In Vermont, the majority of breast cancers are diagnosed at the localized stage – the most treatable stage before the cancer has spread.”
- Colon (colorectal) cancer: Screening for colon cancer is recommended for those ages 50 to 75. Although only 63 percent of all Americans in that age group were screened for colon cancer, 71 percent of Vermonters were. Healthy Vermonters believes this could be increased to 80 percent.“Colorectal cancer kills more Vermonters than any other cancer except lung cancer,” the report says. “Each year, approximately 300 people are diagnosed, and 100 die from the disease. Colorectal cancer develops slowly, so early diagnosis often leads to a complete cure.”