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Framing the Discussion MAY 16, 2014

Protecting People through Tribal Public Health Codes: Legal Technical Assistance and Resources for Tribes and Tribal Serving Organizations. Framing the Discussion MAY 16, 2014. Jennifer Giroux, MD, MPH Medical Epidemiologist Great Plains Area Indian Health Service

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Framing the Discussion MAY 16, 2014

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  1. Protecting People through Tribal Public Health Codes: Legal Technical Assistance and Resources for Tribes and Tribal Serving Organizations Framing the Discussion MAY 16, 2014 Jennifer Giroux, MD, MPH Medical Epidemiologist Great Plains Area Indian Health Service Great Plains Tribal Chairmen’s Health Board Northern Plains Tribal Epidemiology Center The findings and conclusion of this presentation are those of the author and do not represent the official position of the IHS, GPTCHB or anyone else

  2. American Public Health System

  3. Surveillance of Infectious Diseases Among American Indians/ AK Natives Bertolli et al, 2008

  4. Surveillance of Infectious Diseases Among American Indians/ AK Natives Bertolli et al, 2008

  5. Multistate Assessment of Public Surveillance Relevant to AI/ AN, 2007, Bertolli et al 2011 • Assessed collaboration between state health departments and AI/AN Tribes and agencies • On-line survey by State Epidemiologists • 39 states with federally recognized or state-recognized Tribes or federally funded urban Indian Health centers • 25/39 (64%) responded • 19/25 (76%) had discussed PH surveillance with AI/AN gov’t in last two years • 10/19 (53%) had ongoing, regular discussions about public health surveillance • 9/19 (47%) had discussions as needed • 9/25 (36%) had a state POC for PH surveillance with Tribes • 4/25 (16%) had an active MOU with AI/AN gov’t • Functional relationships between state health departments and AI/AN gov’t / agencies have not been consistently established

  6. Public Health “ The science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals." Winslow, Charles-Edward Amory (Jan 9, 1920). "The Untiltled Fields of Public Health". Science51 (1306): 23–33. doi:10.1126/science.51.1306.23. PMID17838891.

  7. Public Health Approach Public Health Model • Medical • Model Versus

  8. Public Health Ten Essential 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

  9. Need for Integration of Tribal Nations into American Public Health System, Reportable Disease Surveillance System Inadequate local Tribal public health infrastructure and State public health codes to respond to surveillance results Need for Tribal-designated public health authority, Need for Tribal public health codes, Need of modernized state public health codes that interface with Tribal governments

  10. Need for Integration of Tribal Nations into American Public Health System, Reportable Disease Surveillance System Absence of formal agreements between Tribal governments and state departments of health. Multiple jurisdictions involved (IHS, Tribes, states) that may not know each other’s role and function within the reportable disease surveillance process. Tribes have no involvement in submission of reportable disease data where IHS provides direct services

  11. Need for Integration of Tribal Nations into American Public Health System, Reportable Disease Surveillance System No standardized methodology for the analysis of reportable disease data for the 566 Tribes, including: Agreement on denominators, Models for small area estimation, Need for incidence and trends but need to aggregate years to stabilize data, and Laws that take into account both state laws on reporting small numbers and Tribal need to know of even single cases of some infectious diseases

  12. Acknowledgements . Thanks to • Dr. Corey Smith • Dr. Jeanne Bertolli • Tribal Health Directors I have learned along side with This project has been made possible through a grant to the University of Pittsburgh Graduate School of Public Health Center for Public Health Practice from the Centers for Disease Control and Prevention Public Health Law Program through a sub-award from the Association of State and Territorial Health Officials

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