**Background:** This study investigates food justice issues in Vermont's environmentally vulnerable communities—areas with higher proportions of residents of color and low-income residents that also carry heavier environmental, health, and social burdens. Vermont is the second most rural U.S. state (65% rural population), with 92.5% white population and 10.2% living in poverty. Despite a strong local food movement and agricultural economy ($11.3 billion economic output in 2017), locally sourced food is often unaffordable for low-income populations. Previous data from the 2018 Vermont BRFSS showed 13% of BIPOC and 14% of adults below the poverty line were food insecure, compared to 4% of white residents and less than 7% of those above poverty. The study aims to examine how food access is influenced by income, race, and gender, identify gaps in food assistance programs, and connect food justice with environmental justice frameworks.
**Methods:** The research team first conducted spatial analysis to identify Vermont census tracts with the highest quartile of cumulative environmental disparity scores, incorporating environmental risk factors (traffic noise, air pollution, brownfields, landfills, Superfund sites, impaired surface water, lead in school drinking water, flood hazard, heat vulnerability), health risk factors (cancer, diabetes, obesity, lung disease, cardiovascular disease), and social vulnerability indicators (poverty, unemployment, education, health insurance, disability, minority status, limited English proficiency, housing characteristics, food access). Data collection included: (1) door-to-door surveys (n=569) conducted May-August 2019 using a 58-question instrument, with oversampling of BIPOC (14% of respondents vs. 5.9% state average) and low-income residents (40.9% below $25,750 vs. 11% statewide); (2) semi-structured interviews (n=32) with community organizations, state agency staff, and legislators conducted 2019-2020; and (3) five focus groups (two in-person pre-COVID, three virtual during COVID with migrant farmworkers, Bhutanese Nepali immigrants, and Somali Bantu immigrants). Quantitative analysis used binomial logistic regression in SPSS to calculate odds ratios at 95% confidence intervals, with gender, race, and poverty line as independent covariates.
**Key Results:** Income was the strongest predictor of food insecurity. Respondents below the poverty line were three times less likely to have good access to fresh healthy food (OR: 0.29, CI: 0.128-0.66, p=0.003), seven times less likely to eat fresh produce weekly or daily (OR: 0.136, CI: 0.044-0.424, p<0.001), five times more likely to have gone hungry in the past month (OR: 5.277, CI: 1.568-17.761, p=0.007), and two times more likely to have trouble affording food (OR: 2.584, CI: 1.255-5.323, p=0.01). Women faced higher food insecurity than men—over two times less likely to have access to fresh healthy food (OR: 0.39, CI: 0.166-0.918, p=0.031) and almost three times more likely to have trouble affording food (OR: 2.953, CI: 1.354-6.442, p=0.007). BIPOC respondents were almost three times more likely to have trouble affording food than white respondents (OR: 2.832, CI: 1.249-6.423, p=0.013). Health outcomes were also associated with food access: those below poverty were twice as likely to report cardiovascular disease (OR: 2.272, CI: 1.118-4.618), and those who had trouble affording food were two times more likely to have asthma (OR: 2.148, CI: 1.146-4.026, p=0.017) and autoimmune disorders (OR: 2.617, CI: 1.103-6.207, p=0.029). Qualitative findings revealed that food was often the first expense compromised when facing competing costs (rent, utilities, medical expenses). Interviewees identified a "benefits cliff" where people earning just above SNAP eligibility thresholds still cannot afford adequate food. Resettled refugees and migrant farmworkers faced additional barriers including lack of culturally appropriate food, limited access to land for growing food, and restricted shopping frequency (employers took migrant workers shopping only twice monthly). Environmental concerns intersected with food access—low-income (38%) and BIPOC (37%) respondents were slightly more likely to eat fish from local lakes, but focus group participants reported that fish from Lake Memphremagog could not be safely consumed due to contamination from an active landfill and blue-green algal blooms.
**Clinical Implications:** This study demonstrates that food insecurity in environmentally vulnerable communities is not merely a distribution problem but intersects with multiple social and environmental injustices that create self-reinforcing cycles of poverty and poor health. The findings highlight the need for healthcare providers and policymakers to recognize that food insecurity is closely linked to chronic disease burden—asthma, cardiovascular disease, and autoimmune disorders were significantly more prevalent among those with food access problems. Clinical screening for food insecurity should be paired with interventions that address the underlying structural barriers, including transportation limitations, the "benefits cliff" in assistance programs, and the need for culturally appropriate food options. The study also underscores the importance of an intersectional approach that considers how race, gender, income, and environmental exposures (such as agricultural chemicals, PFAS contamination, and water quality issues) compound to affect community health. For migrant farmworkers and resettled refugees, food insecurity cannot be separated from issues of labor exploitation, occupational health, and limited healthcare access. Addressing food justice in clinical and public health practice requires moving beyond food provision to building community capabilities, ensuring procedural engagement of marginalized populations, and tackling the broader environmental and economic determinants of health.