Race, COVID-19 And Health Disparities In Vermont

Jun 8, 2020

Nationwide, people of color have tested positive for COVID-19 at higher rates than white people and experienced worse outcomes from the disease.

This trend is as evident in Vermont as anywhere, and has been bolstered by a recent outbreak of the disease in Winooski. There, according to Seven Days, at least 31 of 34 new cases are black or Asian people.

While nonwhite Vermonters are just 5.9% of the state’s population, they are 9.2% of Vermont's COVID cases, according to the state’s Department of Health. Experts say social and systemic racism, economic inequality and inadequate public outreach are all factors driving the disparities. 

Vermont's COVID-19 demographics

Black Vermonters in particular have suffered from the virus at particularly high rates. Hispanic Vermonters have also contracted COVID-19 at higher rates than their non-Hispanic neighbors. 

Jarvis Chen, a lecturer in social and behavioral sciences at Harvard’s Chan School of Public Health said Vermont’s statistics are not surprising.

“It's a pattern that we're seeing across many states in the country,” he said. Communities of color have “excess risk,” he said, not just of contracting the illness, but also of dying from the disease. 

A note about the data below: The term "nonwhite" refers to black, Asian, indigenous, and "other," as indicated to the Department of Health and the US Census. It does not include Hispanic or non-Hispanic designations, which DOH and the US Census track separately. While VPR recognizes that racism and health disparities affect different communities differently, we have opted to combine nonwhite race data to reduce statistical inaccuracies caused by small sample sizes.

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According to the Vermont Department of Health, 68% of Vermonters of color who got COVID-19 had comorbidities like heart disease and diabetes, compared to 63% of white Vermonters who contracted the virus. Chen said scientists “definitely know” that these comorbidities increase a COVID-19 patient’s risk of severe illness and death. 

On top of that, he said, “there do seem to be some suggestions in the data that having comorbidities might also increase your risk of being infected.” 

The fact Vermonters of color have not faced a disproportionate rate of death from COVID-19, Chen said, may reflect the fact that these communities tend to be younger than white communities, and age has proven to be a powerful factor in COVID-19 outcomes.

In 2018, 19% of white Vermonters were 65 or over, compared to 7% of people of color, according to the U.S. Census. For that reason, he said, “it's possible that some of the rates that we've been looking at in the published data from Vermont might be understating the extent of the racial ethnic disparity.”

Adjusting the data for age, he said, would likely result in a more stark disparity in hospitalization and fatality rates.

Inside the Northwest Regional Correctional Facility in Franklin County — the location of a COVID-19 outbreak — racial disparities are particularly striking. While black people make up 9.5% of incarcerated Vermonters, they make up 17.8% of those who have gotten COVID-19 behind bars.

In addition to structural inequalities, Chen said, COVID-19 is an infectious disease, which means it spreads among social networks. If inmates choose to socialize with people who look like them — once one person gets the virus, Chen said, "that whole social network can get infected.” 

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Behind the numbers

Where you work, how many people you live with, whether you have access to personal protective equipment, and whether you have paid sick days all influence one’s risk of exposure to COVID-19, Chen said — as does racism.

“Racism plays a huge role in affecting the health of communities of color,” he said, pointing to both to conditions like food and housing insecurity that result from structural racism, as well as the stress of experiencing discrimination. 

Maria Mercedes Avila is an associate professor of pediatrics and the health equity liaison at the Larner College of Medicine at the University of Vermont.

"Sometimes, when we live in states that are defined as progressive or liberal, people tend to think that systemic racism is not a problem," Avila said, "and this is actually a bigger problem.”

Avila pointed to the racially discriminatory lending practices known as "redlining," gentrification, exposure to poverty, food insecurity, school suspension rates, covert racism, and inequitable access to healthcare all as drivers of health disparities in Vermont. 

One relevant data point comes from a recent survey conducted by the University of Vermont. It found that non-white survey respondents were more than twice as likely to be food insecure in the year prior to COVID-19 as white respondents. 

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With COVID-19, housing disparities may accelerate spread in certain communities, especially if younger family members work in essential industries. Census data shows that in Vermont, people of color are twice as likely to live in multigenerational households as white people.

The disparity is even more striking in data from northwest Vermont, which includes Chittenden County. There, 3.3% of white people live in households with three or more generations, compared to 11.2% of nonwhite people. 

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“We know how expensive housing is in our state,” Avila said. “When we have a pandemic or an outbreak like the one happening in Winooski, we find that multigenerational housing can affect, for example, isolation or quarantine.”

Avila said she would like to see public health officials be more proactive in protecting underserved communities — not just in responding to positive test results, but also in communicating public health information to diverse communities.

“We need to make sure that we expand the role of community health workers and cultural brokers to address all aspects of social determinants of health,” she said.

Avila said the outbreak in Winooski is a “perfect example” of the need for more community outreach and accessible real-time translation services during events like press conferences.

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The increased risk of living in a multigenerational household may be exacerbated by racial disparities in the economic workforce. A national survey by the Kaiser Family Foundation shows essential workers working outside the home are more likely to be black and more likely to have a household income of under $40,000 than other working adults in the country.

While comparable data isn't available for Vermont alone, VPR analyzed data from the U.S. Census which broke down workers by race and industry in the state.  Using a list of essential industries created by the New York City Comptroller’s offices, we found a less stark disparity in the state’s essential workforce.

The Department of Health's Health Improvement Steering Committee, of which Avila is a member, published a plan last year to address the state's health disparities. But Avila said she most wants Vermonters to educate themselves about the root causes of these disparities.

"Many people don't know the history of this country," she said, listing policies like boarding schools for indigenous children, and discriminatory lending practices. "That lack of knowledge is perpetuating the racial disparities that continue to happen in our society." 

Digital producer Elodie Reed produced the infographics for this story.