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Presented at Public Health and Surveillance Data Meeting Grand Island, Nebraska October 12, 2011

Building the Public Health Front Line in Indian Country Great Plains Tribal Chairmen’s Health Board (GPTCHB) & Indian Health Service (IHS) Public Health Initiatives. Presented at Public Health and Surveillance Data Meeting Grand Island, Nebraska October 12, 2011 Jennifer Giroux, MD, MPH

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Presented at Public Health and Surveillance Data Meeting Grand Island, Nebraska October 12, 2011

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  1. Building the Public Health Front Line in Indian CountryGreat Plains Tribal Chairmen’s Health Board (GPTCHB) & Indian Health Service (IHS)Public Health Initiatives Presented at Public Health and Surveillance Data Meeting Grand Island, Nebraska October 12, 2011 Jennifer Giroux, MD, MPH IHS Field Medical Epidemiologist The findings and conclusion of this presentation are those of the author and do not represent the official position of the Indian Health Service, Great Plains Tribal Chairmen’s Health Board or any other organization or person

  2. Outline • Indian Health Service, Primary Care • Centers for Disease Control and Prevention, Public Health • GPTCHB & IHS Public Health Initiatives • Next Steps

  3. Indian Health Service

  4. Ten Essential Public Health Services • Monitor health status • Diagnose and investigate • Inform and educate • Mobilize communities to identify problems • Develop policies and plans • Enforce laws and regulations • Link people to needed health services • Assure a competent healthcare workforce • Evaluate health services • Conduct research

  5. The End of a Era IHS Area Medical Epidemiologists • Thomas Welty, MD, MPH, • AAIHS Medical Epidemiologist • Strong Heart Study, • Sioux Cancer Study, • Infant Mortality Study, • Hepatitis A Vaccination Trials • 1990’s, IHS phases out Area Medical Epidemiologist • 1996-2003 AAIHS has no Epidemiology Center

  6. Tribal Epidemiology Centers (TECs) • Started in 1996 • Core funding from Indian Health Service (IHS) • Focus to build public health capacity in AI/AN communities • IHS Area to provide technical assistance to AI/AN organizations by placing a epidemiologist with TEC. • 12 TEC nationwide • 11 regionally focused • One nationwide-focus (urban AI/AN)

  7. American Indian and Alaska Native (AI/AN) programs working with Tribal entities and urban AI/AN communities by managing public health information systems, investigating diseases of concern, managing disease prevention and control programs, responding to public health emergencies, and coordinating these activities with other public health authorities Tribal Epidemiology Centers

  8. Rocky Mountain Urban Indian Health Institute Northern Plains WA NH Great Lakes ME VT MT Northwest ND MN MA OR ID SD WI NY RI MI WY CT IA PA NV NE NJ OH IL IN UT California WV DE CO KS MO VA MD KY NC OK AZ TN AR SC NM GA United South & Eastern Tribes TX MS AL Inter-Tribal Council of Arizona, Inc. AK LA Navajo FL Albuquerque Area Southwest Southern Plains Alaska Native HI TRIBAL EPIDEMIOLOGY CENTERS (TECs)

  9. U. S. Public Health System

  10. Great Work by CDC Staff on the Front Lines24-AUG 11, excerpt from CDC Director’s email to CDC staff “CDC provides effective support to state, tribal, local, and territorial public health agencies through funding, guidance, and technical assistance.  One of the most effective ways we do this is through embedding CDC staff at state and local levels.  We currently have 520 assignees at state and local health departments, and even with budgetary challenges, we hope to increase these numbers.  As CDC staff work on the frontline of public health along with our state and local partners, we can increase the efficacy of our grant and cooperative agreement funds and establish critical feedback loops so that our Atlanta- and field-based staff have a common understanding of the challenges and opportunities to reduce threats to health, safety, and security.”

  11. The 10 Essential Public Health Services THE THREE CORE PUBLIC HEALTH FUNCTIONS Assessment • Monitor health status to identify community health problems • Diagnose and investigate health problems and health hazards in the community • Evaluate effectiveness, accessibility, and quality of personal and population-based health services Policy Development 4. Develop policies and plans that support individual and communityhealth efforts 5. Enforce laws and regulations that protect health and ensure safety. • Research for new insights and innovative solutions to health problems Assurance 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable 8. Assure a competent public health and personal health care workforce 9. Inform, educate, and empower people about health issues 10. Mobilize community partnerships to identify and solve health problems

  12. Surveillance of Infectious Diseases among AI/AN (Bertolli et al)HIV/AIDS, STD, TB, Hep A, B, CJournal of Health Disparities Research and Practice Vol 2, Number 2, Spring 2008, pp 121- 144 • IHS facilities • Case reporting • variation between diseases, all > 90%, • Received results • range 29-37% state • Tribal/ Urban facilities • Case reporting • variation between diseases, range 62-71%, • Received results, • range 11-16% county, range 21-27% state.

  13. Surveillance of Infectious Diseases among AI/AN (Bertolli et al) • Barriers: • lack of trust between Tribal authorities and state/local gov’t due to limited knowledge of surveillance, • lack of feedback to I/T/U • gaps in coordination

  14. CDC and State Cooperative Agreements

  15. What’s the Association between Development of Public Health Infrastructure in Indian Country & CDC’s Tribal Advisory Committee and Tribal Consultation ? • Office of the CDC Director: Dr. Frieden • Office of State, Tribal, Local and Territorial Support, Director: Dr. Monroe, • Associate Deputy Director: Dr. Greg Holzman, • Associate Director for Tribal Support: TBD • Leads Tribal Advisory Committee (TAC) meetings • Last engaged Representative Robert Moore • GPTCHB Tribal Representative Chairwoman White, alternate Deleen Koughl • Responsible for Tribal Consultation and ensuring agency compliance • Number Tribal consultations – 6? Formal agency response ? • Secretary’s Tribal Advisory Committee (STAC), • Secretary’s Interdepartmental Council on Native American Affairs (ICNAA), • HHS AI/AN Health Research Advisory Council (HRAC),

  16. GPTCHB & AAIHS Public Health Initiatives • GPTCHB new mission statement Great Plains Tribal Chairmen’s Health Board improves the health of American Indian people through Tribal partnerships andpublic health practices while respecting Tribal sovereignty and traditional values. • Tribal Epidemiology Centers • Grants/ Cooperative Agreements: CDC, NIH, IHS, APTR, OMH, etc • Integration of 10 Essential Public Health Services into TEC’s self-evaluation • Highest: Research, Assure a competent PH and personal health care work force, • Lowest: Monitor health status, Diagnosis and Investigate, Develop Policies and Plans

  17. GPTCHB & AAIHS Public Health Initiatives (cont.) Northern Plains Tribal Public Health Summit • Overview of Public Health Assessment and Strategic Planning Instruments • 2004-05 Service Units and Tribal Public Health Systems Assessment • Tribal Public Health Accreditation • National Tribal Public Health Assessment Results • Tribal Health Directors Strategic Planning Session - collective prioritization of 10 EPHS priorities and technical assistance needs, recommended next steps

  18. GPTCHB & AAIHS Public Health Initiatives (cont.) • Site visits with all Tribal Health Directors (2010- 2011) • Individual assessments, identified THDs public health, epidemiology and research priorities (available), new partnerships, exchange of knowledge about programs • NE: Omaha, Ponca • GPTCHB and AAIHS programs meeting, (12/6/2010) • Opportunity for alignment and collaborations • CBA HIV: reduce HIV testing stigma during school physical, IHS: HIV testing not done during school physicals • Diabetes Audit

  19. GPTCHB & AAIHS Public Health Initiatives (cont.) • State Health Department meetings (SD DOH 3/15/ 2011, ND DOH 9/8/ 2011, NE DHHS 10/12/2011) • AI State Health Profiles, current AI data: MMWR on SD AI mortality 2000-2009, ND DOH duplicated mortality analysis, moving toward reservation’s specific data. Diabetes Audit collaborations, need for data workgroup………

  20. Next Steps ? • Cooperative Agreement / Grants • Federal: CDC put language into Cooperative Agreements/ Grants encouraging states to develop formal MOU/ agreements with Tribes and IHS • State: States start review data and start exploring where this might have a greatest benefit in addressing AI health disparities • Local/ Tribe: IHS/Tribes need to identify with position could serve as a Public Health Officer for the Tribe.

  21. Next Steps ? (cont.) • Operationalization of TAC, Tribal Consultation • Federal: TAC– Convert to workgroups, may need to pay Tribal positions due to lack of current public health infrastructure– use IHS CDC assignees due to experience. Meet and update Health Boards • State- Request the documents of these Tribal consultants. What do Tribes in your region need. Create PH strategic plan with Tribes in your state. • Local/ Tribe: Request documents of these Tribal consultation. Have Tribal representatives attend meetings or if not able to ensure GPTCHB Technical Assistance person does. Invite CDC to come and present to GPTCHB Chairmen on results and agency response. • Data Work Group • Federal: Develop guidance, templates • State: Determine current status • Local: Identify Tribal contact or person with SME, align with in Tribe on data policies and procedures

  22. Next Steps ? (cont.) • Stabilize TECs • Federal: Consider core funding or funding a National TEC Surveillance Initiative • State: Consider assigning CEFOs to work on project with Tribes/ Health Boards/ TECs • Local / Tribe : Request CDC to include Tribes, Health Boards/ TECs in funding opportunities for county health departments

  23. Next Steps ? (cont.) • Stabilize current CDC assignees to IHS/ Expand assignments to include Tribe /Tribal Health Boards/ TECs • Federal: Consider using current assignees to create an American Indian Public Health Institute- Cross Cutting Team working to serve all of Indian Country • State: Have state’s CDC assignee work on project with Tribes and IHS • Local/ Tribe: Request CDC assignees at Tribe or Health Board or request their SME

  24. Jennifer Giroux IHS Medical Epidemiologist 605 721-1922 ext 106 work 605 430-0286 work cell Great Plains tribal Chairmen’s Health BoardNorthern Plains Tribal epidemiology centerAberdeen Area Indian Health serviceIndian health Service Division of Epidemiology and disease Prevention

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