Measles Cases on the Rise

Measles cases are rising in the United States (US), and Vermont recently had its first case of measles since 2018. As of May 3, 2024, there have been 131 cases of measles in the US this year, already more than double than in all of 2023. Measles is one of the most contagious viruses and can cause serious illness in some people, like babies, young children, and people with weakened immune systems.

Reversing an Historic Public Health Achievement

According to the US Centers for Disease Control and Prevention, “Measles was officially eliminated from the United States in 2000†, meaning there is no measles spreading within the country and new cases are only found when someone contracts measles abroad and returns to the country. Achieving measles elimination status in the US was a historic public health achievement. The below figure illustrates how common measles was before vaccines and how vaccine policy enabled elimination.”

Source: https://www.cdc.gov/measles/cases-outbreaks.html
*2023 data are preliminary and subject to change.
†Elimination is defined as the absence of endemic measles transmission in a region for ≥ 12 months in the presence of a well-performing surveillance system.

No Longer at Herd Immunity Levels in All Places

The risk of widespread outbreaks in Vermont and the US is low because of high vaccination rates, but communities with less than 95% vaccine coverage rates are at higher risk for outbreaks.

The 95% number is important because when more than 95% of people in a community are vaccinated, most people are protected through community (or herd) immunity. This includes protection for people who are unable to be vaccinated for medical reasons and/or are medically vulnerable to even mild cases of measles. However, vaccination coverage among U.S. kindergartners has decreased from 95.2% during the 2019–2020 school year to 93.1% in the 2022–2023 school year, leaving approximately 250,000 kindergartners at risk each year over the last three years.

  • Vermont’s Kindergarten MMR Vaccination Rate for 2022/2023: 93.1%
  • New Hampshire’s Kindergarten MMR Vaccination Rate for 2022/2023: 89.4%

What Happens If my Child is Not Vaccinated

There are a few reasons why a child may not receive vaccinations like the MMR; these include medical exemptions and religious exemptions. No matter the reason, people who have not been vaccinated are at increased risk of disease and/or spreading the measles virus if they are exposed.

In Vermont, the Department of Health has asked School Nurses to proactively let parents of children with exemptions or provisional admittance know that their children will need to quarantine for up to 21 days if there is an outbreak in the school. This can help parents prepare for the potential disruption of keeping their unvaccinated children home for 3-weeks. Such steps have also been part of New Hampshire rules; however, it is unclear what the State guidance may be at this time.

For more Information about Measles Vaccination, Health Impacts, and Outbreaks:

To Get Vaccinated

Both New Hampshire and Vermont offer vaccines free to children. The links above will provide information about how to request a free vaccine, though in both states you generally start with your regular health care provider or a federally qualified health center or free clinic.

In Vermont, if you do not have health insurance and are under the age of 65, you can also make an appointment at your Local Health Office to get vaccinated. Local health offices do not charge a fee for giving the vaccine.

Promoting Youth Engagement and Advocacy

Andrea Smith facilitating a panel discussion with Senator Prentiss, Representative Sullivan, and Representative Damon.

In 2022, the NH Charitable Foundation announced a pilot grant opportunity available to the 13 Regional Public Health Networks (RPHN) in New Hampshire that focused on public health community engagement and advocacy. According to the Foundation, they had come to understand that “community-based partners working to advance public health and behavioral health equity are often challenged by funding restrictions, which can prevent meaningful, and needed, participation in policy and advocacy efforts (New Hampshire Charitable Foundation, 2022).”

The purpose of the grant is to support community engagement, advocacy and lobbying efforts on a broad range of public health topics. Areas of interest include substance use, mental health, children’s behavioral health, childhood immunizations, early childhood development, and other relevant public health issues. This was a direct result of legislation introduced in the 2022 Legislative Session to reduce public health’s infrastructure. The Upper Valley and Greater Sullivan County RPHNs both applied and were awarded this grant.

Youth Advocacy Event

On October 27th, 2023, RPHN staff, Andrea Smith and Deryn Smith, hosted a Youth Advocacy Event in partnership with New Futures, and the New Hampshire Charitable Foundation. At this event, high school students from each of the Upper Valley and Greater Sullivan County Regions earned what advocacy is, why it is so important, and how youth can be involved in life changing advocacy work. The students participated in a panel discussion with local legislators, including Senator Prentiss, Representative Sullivan, and Representative Damon, to hear firsthand why youth voices are so impactful, best practices for youth to participate in advocacy work, and ask questions of the panelists.

Students and an advisor from the Sunapee Middle/High School learn about advocacy.

“It was clear that the students are passionate about making a difference in their school, community, and nation, and providing them with information on how they can enact positive change with their own voices was extremely impactful. Every New Hampshire resident can advocate for what is important to them, so I am excited to see how these students take the information they learned and advocate for what they are passionate about.” – Deryn Smith, Substance Misuse Prevention Coordinator, Greater Sullivan County Regional Public Health Network.

Special thank you to Lebanon’s Kilton Library for generously allowing us to use their Community Room to hold this event.

— Submitted by Andrea Smith, Senior Community Health Partnership Coordinator, Dartmouth Health

Workforce Crisis Needs Policy Solutions

Kate Luczko of HealthForce NH, discusses healthcare workforce programs in New Hampshire.

The Public Health Council of the Upper Valley (PHC) hosted the Upper Valley Bi-State Legislative Breakfast on Monday, November 6, 2023. The purpose was to provide state-level legislators from the Upper Valley region with information, stories, and policy guidance on the many levels and layers of workforce challenges impacting health and wellbeing in our region. Goals included:

Develop relationships with legislators.
Educate about policy related issues.
Promote cross-border awareness/collaboration on issues.
Help legislators become more responsive to the needs of constituents.

The agenda included presentations by leaders in education, housing, childcare, and local health care from both NH and VT.  We had 31 people in attendance, including five NH Representatives, two VT Representatives, and two VT State Senators.

Report of Proceedings and Recommendations

The PHC recently released a report from the event, including a summary of the issues discussed and the policy recommendations that emerged: PHC 2023 Legislative Breakfast Report.

Through presentations and discussion, the meeting highlighted a few key messages for policymakers relative to the health care workforce crisis. These include:

  • the healthcare workforce is struggling, even more so after the pandemic, and with the aging of our populations, the crisis will only worsen;
  • current and potential healthcare workers at all levels need ready and affordable access to (continuing) education, childcare, and housing if they are to do this critical work; and
  • all of these required supports face real barriers right now that must be addressed together.

As speakers and panelists laid out challenges and opportunities for policymakers to consider, a general understanding of the workforce crisis emerged.

Healthcare Workforce Struggles
  • Job openings in healthcare have grown consistently since 2019. Both job postings and hiring have increased, particularly in nursing positions. However, the skilled healthcare workforce is aging, and younger workers are not stepping up to fill the gaps. This is happening at a time when our populations are aging and in need of more healthcare.
Workforce Education & Training
  • Higher Education must be allowed and supported to adapt to meet current and future workforce needs.
  • For nursing-related professions, universities struggle to recruit professors to teach as travel and per-diem jobs pay much more than universities can. Many people who work in the field and have been willing to teach part-time are no longer able to due to shortages in their own workplaces.
  • Clinical placements are an essential part of preparation, but the workforce shortage means that potential preceptors do not have the capacity to mentor students.
  • This is a vicious cycle. Lack of time to teach leads to fewer students graduating, which leads to a lack of staff to hire, which leads to a lack of time to teach.
No Place to Live
  • One reason healthcare employers are struggling to recruit and retain employees is the difficulty in finding affordable housing near enough to work. Our region needs 10,000 more housing units by 2030 to keep up with current demand. The current pace of building is nowhere near this level.
  • Many younger people, who are critical for our workforce, cannot find “middle ground” housing such as townhouses or condos when they want to start a family. They are forced to move to other areas to find a balance of work, housing, and childcare.
  • Lack of housing is limiting the vibrancy and diversity of our area.
Who Cares for the Caregivers’ Children?
  • The importance of early childhood care and education has been neglected. The childcare crisis is not new. but has worsened since the pandemic. There were thousands of childcare job vacancies prior to COVID-19 and that number has only grown.
  • Childcare serves two vital roles in our communities that must be respected and supported: 1) we need the younger workers who need childcare to work and 2) young children need the jump start in education and social-emotional skills to be ready to succeed in kindergarten and beyond.
  • We must shift our thinking away from childcare being an option or a luxury for families. Most families cannot survive, much less thrive, without safe, quality, affordable care for their children.
It Will Take All of Us to Fix This
  • To address these inter-connected challenges, collaboration between all stakeholders is critical. This includes businesses, state policymakers, municipalities, educational facilities, and non-profit organizations.
  • When businesses help fund degrees, they are guaranteed employees to fill positions, and graduates are guaranteed a job.
  • The PHC also encourages all residents of the Upper Valley to advocate for legislation that addresses the issues of most concern here in the Upper Valley. To learn more about organizations that specialize in advocating, please use the PHC resources available on our Advocacy Page.

PHC and members of the Planning Committee wish to thank all the elected officials who joined us for this event and the many local experts who came to share their wisdom and experience. We hope this report will provide a guide for our policymakers over the next year of legislative activity.

Upper Valley Community Health Equity Partnership

In March 2022, the Public Health Council signed on as the Backbone Organization for the Upper Valley Community Health Equity Partnership (UVCHEP), on behalf of the White River Junction District Office of the Vermont Department of Health. The project was funded through a US Centers for Disease Prevention and Control (CDC) grant awarded to the Vermont Department of Health (VDH) to “mobilize partners and collaborators to advance health equity and address social determinants of health as they relate to COVID-19 health disparities among populations at higher risk and that are underserved.”

The grant allowed us to bring on temporary staff to manage the project, engage local partners, and design a community-grants process. We recruited local people with personal understanding of health disparities and inequity to steer the project, providing insights, connections, and making decisions about the use of grant resources. Finally, the grant provided funds – ultimately $168,000 – for community grants that addressed a data-driven problem identified by our Steering Committee.

The UVCHEP Community Goal/Vision: The Upper Valley is a lively, growing, safe, and inclusive community where, by working together, marginalized communities have access to the power and resources necessary to ensure equitable access to health care, education, housing, food security, and other socioeconomic needs.

The UVCHeP Data Driven Problem Statement: Black, Indigenous, and People of Color (BIPOC) as well as Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual and plus (LGBTQIA+) community members have higher levels of mental health challenges and substance use disorder, diagnosed and undiagnosed. These conditions are both caused by and contribute to isolation, other chronic health conditions, and not feeling safe.

Between October 2022 and January 2023, the Steering Committee invited two rounds of grant applications, with the goal of reducing the barriers that traditionally prevent groups and organizations most closely connected to the people who experience health disparities from getting funding and other resources to address health disparities in their own communities. The Steering Committee selected ten (10) organizations to receive grants ranging roughly from $6,000 to $35,000. The grant period ran from December 2022 through November 2023, with some variation in project dates.

We are pleased to share the community projects with our community. Below are summaries of each of the organizations and projects. We have provided links to other sources of information when available. In a few cases, we have provided links to additional posts that the projects created to tell their own story.

Abenaki Garden
The Abenaki Garden project is providing food, teaching Abenaki gardening, culture and history in the Upper Valley. Planning began 2 years ago, and work started at the garden in August 2022 to prepare the space for winter and plant some trees and bushes. The “Abenaki Garden” project presents traditional Abenaki agriculture to the public. Utilizing food source trees, berries, herbs and vegetable varieties native and cultivated for thousands of years in Vermont, the garden recreates the concept of N’dakinna (New England) before 1492. A Fire Circle also creates a place for Abenaki speakers to tell stories, teach Abenaki culture and perform public ceremonies for public education events. Inspiration to create this space came upon reading a plea from an Abenaki Chief asking folks with land and gardens to take their gifts of ancient seeds and grow them to share the food with the tribe because they had lost all their land and needed the food. Thus, the true purpose of this project is to grow food for the Abenaki Peoples. Seeds for the project are donated by Abenaki Bands. Funds helped buy materials to construct the fencing, build a rain barrel watering system, compost, trees, bushes, and supplies. More about the Abenaki Garden.

AthletaFit
AthletaFit provides an online 8-week strength training program through the Trainerize app, with the support of a trainer with experience of the BIPOC and LGBTQIA+ community. Grant funding allowed the grantee to develop marketing and outreach to members of the BIPOC and LGBTQIA+ communities in the Upper Valley. AthletaFit seeks to address the health disparities of higher levels of mental health challenges and substance use disorder by reducing isolation and improving chronic health conditions among these underserved populations. Look for VT AthletaFit on Facebook at: https://www.facebook.com/VTAthletaFit

Community Resilience Organizations
Community Resilience Organizations of Vermont (CROs) support grassroots community organizing by people most likely to be harmed by and marginalized by large scale emergencies, such as Hurricane Irene and the COVID pandemic. CROs’ programs support the health and wellbeing of grassroots organizers in underserved, marginalized communities, and scales them up with a concerted geographical focus. As part of this grant, CROs built out their Community Wellness Program and Grassroots Organizing Hub in the White River Junction area with programs designed for BIPOC, LGBTQA, and other marginalized grassroots organizers. The goal is twofold: 1) to offer “community wellness gifts” to marginalized and unpaid organizers who experience burn-out or trauma as a result of their work and 2) to engage with new healing practitioners in providing these gift services as paid for by CROs. More about CROs.

Liberation Library (Every Town)
The Liberation Library is a space for BIPOC in the Upper Valley to gather, create, learn, and share. The library offers books, tools, art supplies and digital resources on loan at no cost and also serves as a gathering place for events, performances, craft shows and more and will be a model shared with other communities. The Liberation Library strengthens several current partnerships with New England Farmers of Color’s (NEFOC) Every Town project. For example, Vermont Releaf Collective members have access to all programming. With over 260 Releaf members, a large concentration of whom are in the Upper Valley, this serves as a central gathering and sharing place for members of this virtual BIPOC Vermonters collective. The Neighbors Network holds anti-oppression book groups and skill shares, increasing the number and quality of anti-oppression trainings and skill shares available in the area as well as increasing conversation about race and the associated awareness and solidarity in our communities and Just Construction, a collective of volunteer carpenters, offers free building and tool safety classes. You can learn more about the Liberation Library at Vermont Public and about the NEFOC at: https://nefoclandtrust.org/.

One Heart Wellness Cooperative
One Heart Wellness Cooperative is a cooperative local space where member organizations and individuals can enjoy and offer quality, accessible, holistic practices, products, and services. Leadership is diverse and committed to providing space for affinity groups to host programs created by and for their communities. The cooperative also serves as an incubator space for small business development, including BIPOC and LGBTQIA+-owned businesses. As a cooperative, One Heart Wellness is owned and operated by the membership with a goal of ensuring membership fees are not a barrier to joining. More about One Heart Wellness.

Safe Spaces for BIPOC
Safe Spaces creates space for Black, Indigenous, and other People of Color (BIPOC) and Aspiring White Allies to connect, learn, and heal as we fight for our collective liberation. Safe Spaces strengthens individuals, communities, as well as institutions, businesses, and agencies through creating partnerships with other established racial justice organizations to provide guidance, resources, and physical and figurative space to work through systematic, systemic, and institutional prejudice and racism. Program offerings include: BIPOC Youth Programs (Read It & Eat it, Jol Indaba), Family Programs (Soul Food Programs, Game Nights), Adult Programs (BIPOC Women’s Group, Social Club), and special events from covering topics such as Mental Health in the BIPOC community during Winter months, BIPOC Women in Jazz and the Arts, and Growing Financial Literacy in the BIPOC Community. Learn more about Safe Spaces for BIPOC at: https://www.safespaces4.org/.

Storytelling Events for BIPOC and LGBTQIA2S+
Murphy Barney hosted virtual community storytelling and listening events designed for the Upper Valley to honor and share the healthcare-related experiences of BIPOC and LGBTQIA2S+ individuals. The events were in the style of town halls, but the storytellers were community members. Murphy generated the Health Equity Storytelling Report from the events that anonymously summarizes the experiences of storytellers and provides local healthcare providers and decision makers with a roadmap for improving services to BIPOC and LGBTQIA+ community members. By hosting community storytelling events, healthcare institutions receive clear guidance enabling them to provide compassionate, culturally informed, equitable health services. When healthcare institutions listen to the stories of their communities, policies begin to reflect the expressed needs of those they serve. More about Murphy Barney and the storytelling events.

Telling My Story
Telling my story hosted three intensive workshops (14 hours over three days) with mental health providers and community members in the Upper Valley that addressed the urgent need for mental health providers to expand awareness and cultural competency with respect to BIPOC and LGBTQIA+ communities and individuals.  Telling My Story workshops were aimed at increasing the cultural competencies, equity orientation, and overall accessibility of mental health providers towards marginalized people. “We do not expect to be able to educate providers on every element of the experience of being marginalized. Rather, we hope to instill awareness of privilege, power, the need to listen, and the need to act to build a more just society.” More about Telling My Story.

Unlikely Riders
Unlikely Riders brings folks together to break and reduce a sense of isolation, foster community connection and conversation, and improve mental wellbeing through investing and supporting BIPOC and LGBTQIA community members with no cost access to winter recreation, education and resources. The grant supported Upper Valley events like community ski and ride days allowing members to ski and ride at no cost, including community instruction and gear (winter layers and snow gear). Our intention through this programming is for folks to be in affinity to build joyful and fulfilling relationships with outdoor spaces and winter in Vermont, New Hampshire, and the Upper Valley. Our work is often in places (ski areas) that have historically been exclusive, inaccessible, and unwelcoming to Black, Indigenous, and People of Color, poor and working-class people, and queer and trans BIPOC folks. Our organization is rooted in creating long-term belonging, healing, and joy through relationship building with winter, snow recreation, and outdoor movement and our leadership is currently all LGBTQIA+ BIPOC folks, two of whom grew up in the Upper Valley area. Learn more about Unlikely Riders at: https://www.unlikelyriders.com/.

Windsor Central Supervisory Union (WCSU)

Windsor Central Supervisory Union Queer-Straight Alliance QSA grant
Student members of Woodstock Middle School/High School’s Queer Straight Alliance (QSA) designed and hosted a Queer Prom open to students at several nearby schools. The dance provided a safe, happy experience for students who might otherwise not attend such events and allowed them to make a typical high school experience uniquely their own. The event’s goals were to decrease isolation and loneliness and increase a sense of belonging, worth, and self-respect. Mental health and LGBT+ service providers also staffed booths and tables at the dance, helping to connect students to resources that can support their mental and physical health long past the event itself. By building relationships with other schools in the region, the hope is that this can become an annual event with shared responsibility for planning.

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The Public Health Council has been honored to participate in this work over the past few years. We hope the Upper Valley will rally around the people and organizations who have taken this opportunity to build programming to address the isolation and discrimination experienced by too many of our neighbors. By supporting this work, we make our communities stronger and healthier.

Abenaki Garden

Abenaki Garden

This garden is situated on land in the Upper Valley that has been home to the Abenaki people for thousands of years. The name of this place means “where the land falls” and within this sacred gorge, we are creating a place to grow the Seven Sisters: Sunflowers, Squash, Corn, Beans, Tobacco, Jerusalem Artichoke, and Chokecherry. We are creating a place to gather, to dance, to tell stories, to host ceremonies, and to continue living in right-relationship with this land for generations to come. We will plant seeds that have been growing here for thousands of years, and that continue to grow in reciprocity with the needs of the land we are tending to. We hope to be able to cultivate and share these seeds widely, as well as sharing the produce with Abenaki families in need, in an effort to heal the land beyond our garden through responsible cultivation of the plants that are integral to the health of our people and local ecosystem.

Abenaki Garden

We are also establishing a food forest where nourishing native foods and herbs can thrive, and, in turn, contribute to the thriving of our community. It has been wonderful to see which foods and plants are already growing in the forest and marsh that we can continue to nurture and cultivate. As we tend to this land, we are also tending to our community through education and sharing stories and traditional agricultural practices with people from all walks of life. Our vision is for this to be a place that all generations can come together and learn from each other, to learn that the Abenaki are still here and eager to teach their traditional knowledge in this time of uncertainty and we want this to be available for generations to come.

Abenaki GardenThere is so much wisdom in our community about this land and what plants can both nurture and be nurtured by this land. Right now, we are in the building phase of this garden, which is a really exciting place to be. We will have a rain collection system installed to sustainably water our plants. Our Board of Directors is Abenaki lead, and we have plans to hire an Abenaki manager for the garden and are currently fundraising to support that person’s work. Our efforts are also centered on finding other sources of sustainable funding, in addition to the funding from VTCHEP that allowed us to purchase some of the initial building materials to make this plan into a physical reality.

Indigenous food sovereignty and community spaces are integral to our health and wellbeing, and the ripple effects are significant. When we have access to land, we have access to sustenance and to an affirming, culturally grounded place to gather and support each other.