Small Towns, Healthy Places

Russ Bennet: You know, it’s the best place on earth. And then after that it gets better. Vermont I think, is woefully misunderstood by the outside world. We’re neighbors first. Somebody runs off the road cause it’s mud season. We threaten not to pull ’em out because they didn’t vote the right way. But we do because we’re neighbors.

Lydia Petty: We went to visit the senior center and we had this incredible conversation with the folks who lived there about how important walking in general was to their lives. It was tender and emotional, even at times like, a number of them said that it literally kept them alive to be able to go out and walk around the town.

Annie Bourdon: There’s two swings next to each other. One of them is universally accessible, the other is not, and it was a tearful, joyful moment the first time that my kids could swing side by side… the surface is smooth. I can push my son in his wheelchair. It overlooks the lake. It’s beautiful..

Suzanne: Welcome to Small Towns, Healthy Places. My name is Suzanne Kelley, and I work for the Vermont Department of Health. Part of my job is to create communities where people have access to be physically active and find healthy, nutritious food.

Richard: And I’m Richard Amore, and I work for the Department of Housing and Community Development. I work with small towns, helping them build vibrant, inclusive and walkable places.

Suzanne: Richard, I just want to say that I am really excited to be doing this podcast with you. You do amazing work, and I think we’re going to have a lot of fun.

Richard: Thank you Suzanne! We’ve done some amazing work together through the years.

Suzanne: I bring the public health perspective, you bring the placemaking and community design expertise. We’re a great team.

Richard: It’s cool that we finally get to share that work with our listeners.
I hope we can inspire folks to make their own communities healthier, vibrant and more inclusive.

Suzanne: Yeah, it’s not as hard as it might seem. People who live in small towns actually have a lot of opportunities to make a difference in their community.

This is so important, because anyone who lives in a small town also knows that it can be hard to access things like fresh food, essential services, and safe places to exercise. Here’s Michelle Gates, Executive Director of the Vermont Garden Network.

Michelle Gates: If you haven’t lived in a small town, you might not realize that you have to walk a mile and a half to the nearest bus stop or drive 45 minutes to get to your dentist appointment. There’s often only one grocery store, and sometimes most of their shopping is done in a convenience store. So, folks that live in small towns really have to prioritize their time a little bit differently than those of us who have easy access to food and medical services and things like that.
And there are a lot of rural communities in Vermont, more rural than urban.

Richard: Vermont is a state of small towns and villages – the average town population size is about twelve hundred people. There are no county governments – these towns pretty much govern themselves. They get some help from state and regional partners, but they’re most often led by dedicated volunteers.

Suzanne: In the past few years, we in the world of public health, have been focusing more heavily on health equity. This has been an important lens for evaluating whether our work is reaching everyone.

For example, data shows that on average, Vermonters are very healthy. We consistently rank among the healthiest states in many national reports.

But if you zoom in on people from priority populations – like people with disabilities, older adults, people of color, and lower income people – it quickly becomes clear that we need to improve our efforts to reach them.

Here’s Bryan Davis, a Senior Transportation Planner with the Chittenden County Regional Planning Commission.

Bryan Davis: Health equity to me… When I hear the term makes me think about, does everyone have access to do the things that make them healthy? Whether that’s physical movement or social connectedness, or the mental support that they need, but it also encompasses other things, more built environment, structural things like, can I get to work today?
Are my children, can they get to school? Can I reach my doctor’s office? Can I check on my neighbors and make sure they’re doing fine? Does everyone have the same access to those kinds of services through their environment?

Richard: We really want to share that the place you live determines your health, wealth and happiness more than anything else.

Here’s Vermont’s Commissioner of Health, Dr. Mark Levine. He gives us a high-level perspective on how the places we live determine health equity.

Mark Levine: It’s almost always your zip code that is way more important than your genetic code, if you want to see what it’s like to be healthy. So, you know, that is illustrated historically in the country…

You know, people know the term redlining and how communities of color often have been really forced to live in certain parts of urban environments or even rural environments for that matter.

And just by the fact that they live there, they have less opportunities to be healthy. They have excess in chronic medical conditions. They have more exposure to air pollution and water pollution, and that’s completely unfair. Health equity is also somewhat inextricably linked to the social determinants of health, as we call it, in public health, which, you know, are all those basic things:
Access to wealth and not poverty, access to housing, food security, transportation, all of those big ticket items. So to really achieve health equity, we really need community strategies to improve access to healthy food places, and to be physically active. We have to be inclusive of individuals in all of the populations ….all of the time.

Suzanne: Richard, what Dr. Levine is describing sounds a lot like what you and I have been working on together.

Richard: That’s right, Suzanne! We work with small towns to build healthy and inclusive public spaces and safe streets. That means accessible parks and village centers, as well as sidewalks and bike paths.

Suzanne: It’s especially great when we can connect “amenities” like schools, libraries, town offices, and local businesses with places to walk and bike. But we know we can do more.
Here’s Dr. Levine again.

Mark Levine: When we talk about health inequity, we always focus. On some of the same kinds of things like race, like gender, et cetera, I always include rurality because rurality turns out to be a determinant of health inequities. Now, rural, as we know, is wonderful. Uh, most of us are living here because of the rural nature, because of the access to the outdoors.

But of course when you have rural, you also have to contend with some of the transportation issues that get involved, some of the weather issues that get involved, et cetera.
If you look at a disease, even like cancer, we’ve learned from the data that the farther you are from a treatment facility, the longer you may go before you actually get the treatment you need, and that will have a direct impact on your outcome.
So rural and the context that that brings in so many areas in health are so critical. And we have communities, unfortunately, that can illustrate all of that.

Richard: Vermonters cherish and love our small towns. As Dr. Levine said, these communities can offer a high quality of life. But some of Vermont’s rural towns have fallen on hard times in the last few decades.

Josh Hanford is the Commissioner of the Vermont Department of Housing and Community Development. He explains why some rural communities are struggling – and how we can help.

Josh Hanford: I think there’s some rural places that they’ve had consistent opportunities, whether, you know, they have local leaders or they have wealth, or they’re a place where visitors have been coming for generations and they’ve sort of developed in a way that has everything you’d want. And then you have rural places that just have been left behind.

You know, they’re not the communities that attract the leaf peepers or the skiers. They had an economy that sort of changed, you know, whether it was, um, a factory or it was, um, forestry in the past, or it was a highly agricultural based community. If you go visit, you’ll see what once was a thriving community, you know, beautiful architecture, beautiful main street, but empty and the communities are, you know, struggling and what is their future, right?

Those communities need some of these basic attributes that really call people to those communities. They need that gathering place. They need that park. They need some interesting art or trails.

They need something to bring the new workers to those communities, and it doesn’t have to be millions of dollars. I mean, we’re talking. Small projects, small little things that, um, that, that make a, a community pop, that make people stop and say, wow, this is a cool town. Look at this. There’s, there’s homes for sale here.

We could actually make this work. Where some of the more discovered communities, they’re already beyond the reach of the average. American looking to settle down, buy a house, maybe, you know, in Vermont from, from more, um, populated areas where we have these hidden gems in Vermont that I think could be, you know, the, the future.

But they need a little investment. They need a little spark to be attractive for folks.

Richard: I’m always talking about that little spark.

Suzanne: You are always talking about that little spark. That’s what placemaking can do, right? It really elevates a town when there are places you can go hang out, talk to your neighbors, and take pride in your community.

Richard: Absolutely! In fact, Commissioner Hanford shared how public gathering places can help build community and promote healthy behavior. He told us a story about a place that was important to him personally.

Josh Hanford: You know, I can think of a community in Vermont I lived in for about 14 years, and we had a park right on Main Street and had a gazebo, and it was the place people gathered on Sunday in the summer. Because there was always some sort of music. You could bring your food, and your lawn chair, and the kids would be playing Frisbee, kicking the soccer ball around.

The adults were chatting, having informal conversations about anything, the visitors to the community that folks that didn’t live there were driving by and saying, wow, look at this community. You know, wow. Look, look what they have here. I wish we had something like that in our town.

But the reality was it’s where ideas sort of generated. It’s where folks saw each other gathering place, and they had these informal conversations that built trust and sort of built a common purpose for what we all could do to make our community better.

Whether it was around the school or it was around, you know, the fire department needing to be, you know, rehabbed. It was a way to, to get together and have those conversations, which. You’re not gonna recreate that in a formal way where you know you’re at town meeting or you’re at some discussion that’s been organized by someone.
This was a low barrier, um, fun way to get that community together mixed with people that were visiting and, and were there. And it’s just, it’s so important to your identity as a community.

Suzanne: A park like Commissioner Hanford describes can be such a valuable part of a community – it allows different people to mix and meet, develop friendships and social connection, exchange ideas, and make their community better as a whole.

When we help Vermont’s small towns with healthy community design, we want to be really intentional about making sure everyone’s voices are heard in the planning process. The idea is “Nothing about us, without us.” Here’s Dr. Levine again, Vermont’s Commissioner of Health.

Mark Levine: You may think that every policy we’ve made, every decision. Every program you’ve designed is like, this is exactly what we need, but until you look at it with a health equity lens, you really have fallen down because you don’t know that it’s going to completely engage and sustain some of those populations that need to have that the most.
So part of that comes with building trust in the populations that you’re dealing with, so that they engage with you on the planning and the design and the implementation. If you’ve been involved in your own planning, you are going to be more likely to exhibit those healthier behaviors because you were part of the planning process in the first place.

Suzanne: During this podcast, we’ll be exploring and sharing how Vermont community leaders are striving to include everyone’s voices in their work. Oftentimes, it means finding creative, non-traditional ways to get input. It means going directly to people from under-served communities, working to build their trust, and asking them how we can include their needs and interests in community projects.

Richard: Here’s a great example, Suzanne. Lydia Petty is vice-chair of the Select board in Northfield, Vermont. Lydia reminds us that well-maintained sidewalks without cracks and bumps are vital for parents, people with disabilities and older Vermonters. But it can be easy for folks to overlook this.

Lydia Petty: We would have a lot more sidewalks if we could maintain them.
And the ones we do have are frequently crumbling and not because anybody wants them to be crumbling, but because of really difficult monetary decisions.

Often in our community, for instance, a lot of people don’t even use the sidewalks, whether that’s because they’re not aware that they’re there or they’re just so used to driving in their car, but you don’t notice a bump in the sidewalk until you have a stroller or a wheelchair or any other mobility device. And even just when you’re walking, um, when you trip, or you can’t go somewhere and it can be such small obstacles, but it’s hard. There’s a challenge to communicate why those problems matter and why they impact inclusivity.

Richard: That pretty much sums it up for me, Suzanne. Lydia is amazing. We’ll be talking to her more in a future episode about her work in Northfield.

Suzanne: Yeah, Lydia’s example really shows us why we need to hear directly from community members. I have another example for you, Richard. Annie Bourdon is a volunteer with Oakledge For All, which is Vermont’s first universally designed playground. You actually heard Annie’s voice at the top of the episode, describing how her two children could finally swing side by side. When we spoke with her, Annie told us about a community meeting where people realized the importance of planning local projects with accessibility in mind.

Annie Bourdon: There’s an anecdote that John from Parks and Rec told me when he was part of the design process for another playground in Burlington: That a lot of the people that attended the public meeting were very opposed to having any sort of paved structures or surfacing in what would become the revitalized playground. And he just asked people to think, ‘well, do you see many wheelchair users who come to this park?’ and the people kind of paused and said ‘no,’ and he said, ‘why not?’ and they physically couldn’t access it. And it was this a-ha moment where people weren’t intentionally trying to leave people out, they just weren’t intentionally including them.

Suzanne: In parallel with this podcast, we have launched a pilot program to work with towns that are looking for help with healthy community design and placemaking efforts. So if a town wants help revitalizing a park or some other public project, they can reach out to us and get assistance to make that happen.

You know Richard, a really unique thing about this program is that we’ve hired a number of “health equity ambassadors.” These are people from priority populations who are passionate about making sure all voices are included in these public projects. They serve as liaisons between planning experts and local community members.

For example, a town might ask us for help installing a crosswalk with a pedestrian signal in a village center. As an able-bodied person, I might not realize that someone with impaired mobility needs a bit more time to cross before the light changes. But a health equity ambassador can point that out and make sure it is accounted for before being installed.

Richard: Yeah, we’re really trying to embrace that idea of “nothing about us without us.” You’ll hear more about the health equity ambassador work later this season.

Our hope is that by supporting community projects in Vermont’s small towns, we can make meaningful and positive change in people’s lives.

For example, you can start with a single gallon of paint to create a temporary sidewalk, or walking path.

We call this a “pop-up project.” Pop-up projects can encourage people to walk more, get to know their neighbors, or even safely visit main street businesses.

Mark Levine: If you have the way to get from point A to point B, that will actually encourage not using your car, but using your feet, you may be more likely to actually do that. You may be more likely to be physically active cuz you can arrive at the playground and actually take your kids there and everybody will; have exercise that they wouldn’t have. If transportation can cut the commute time, people in their very busy lives are then gonna have time earlier, late in the day to engage in healthy behaviors and physical activity that they wouldn’t have found time for before, cuz they have so long to travel. So all of that together, I think, really fits into how this has a rippling effect on people’s lives and health.

Suzanne: That rippling effect is so important to understanding the scope of community design work and placemaking. Richard, I can’t wait to share more about the projects that local residents have been creating in Vermont’s small towns.

Richard: Yeah, I think our listeners are going to be really inspired by what’s possible when you step up, get involved, and take pride in your community. Pretty soon, we’ll connect with the team at LocalMotion, a statewide advocate for active transportation, vibrant communities, and safe streets.

Suzanne: In future episodes, we’re also going to dig deep into topics like parks and green spaces, food security, engaging older adults who live in isolation, housing and zoning, and so much more.

Richard: Thank you so much for listening to Small Towns, Healthy Places. Please, follow the podcast so you can get updates on new episodes. You can find us on Spotify, Apple Podcasts, or your favorite podcast app. Visit healthy-communities-Vee-Tee-dot-com for more information on our Technical Assistance Pilot Program. I’m Richard Amore.

Suzanne: And I’m Suzanne Kelley. We want to thank all of our guests: Dr. Mark Levine, Josh Hanford, Michelle Gates, Lydia Petty, Annie Bourdon and Bryan Davis. You also heard the voice of Russ Bennet. Thank you to Equitable Cities, Health Forward, and Puddle Creative. This podcast is supported by the state of Vermont and the Centers for Disease Control and Prevention. It is produced, written and edited by Sam Peers Nitzberg.