Proposed CDC American Indian/Alaska Native Retention & Recruitment Strategy

1. Proposed CDC American Indian/Alaska Native Retention & Recruitment Strategy By: Cori Bazemore Morehouse School of Medicine/ National Indian Health Board Public Health Summer Fellows Intern 2008

2. AI/AN Demographics 1/3 *AI/AN = American Indian/Alaska Native Source: OMHD CDC http://www.cdc.gov/omhd/Populations/AIAN/AIAN.htm#Disparities • AI/AN* are: • people having origins in any of the original peoples of North, Central, & South America, and • who maintain tribal affiliation or community attachment. • The greatest concentrations of AI/AN populations are in the • West, Midwest, & Southwest, • especially in Alaska, Arizona, Montana, New Mexico, Oklahoma, & South Dakota.

3. AI/AN Demographics 2/3 Source: OMHD CDC http://www.cdc.gov/omhd/Populations/AIAN/AIAN.htm#Disparities • 2000 U.S. Census, those who identify only as AI/AN constitute: • 0.9% of the United States population, or • approximately 2.5 million individuals. • The Census Bureau projects that by the year 2065, those who identify only as AI/AN will constitute: • 1.1% of the population, • topping 5 million individuals.

4. AI/AN Demographics There are 569 federally recognized AI/AN tribes, plus an unknown number of tribes that are not federally recognized. Each tribe has its own culture, beliefs, and practices. 3/3 Sources: OMHD CDC http://www.cdc.gov/omhd/Populations/AIAN/AIAN.htm#Disparities; The Amatua Series Native American History http://www.xmission.com/~amauta/tribes.htm; Jane Louise Curry, Children’s Book Author http://www.janelouisecurry.com/work8.htm

5. Why is it important to have AI/AN employees at CDC? 1/2 CDC needs to reflect the communities that it serves. CDC needs AI/AN employees who are knowledgeable of AI/AN health issues, uniqueness, govt, traditions, etc. CDC needs AI/AN employees that come from tribal communities to work with those communities. CDC needs AI/AN perspective in all areas and projects.

6. AI/AN need to have a voice at CDC. AI/AN need to understand the govt. process to acquire funding and assistance to improve health conditions. There is a need for more AI/AN in the public health profession. Why is it important to have AI/AN employees at CDC? 2/2

7. AI/AN Health Disparities Source: OMHD CDC http://www.cdc.gov/omhd/Brochures/PDFs/1PAIAN.pdf • Major health disparities for AI/AN: • Chronic Diseases • Infant Mortality • Sexually Transmitted Diseases (STDs) • Injuries • Obesity • Mental Health • Substance Abuse

8. 10 Leading Causes of Death AI/AN Population, US, 2004 Source: OMHD CDC http://www.cdc.gov/omhd/Brochures/PDFs/1PAIAN.pdf Heart Disease Cancer Unintentional Injuries Diabetes Stroke Chronic Liver Disease and Cirrhosis Chronic Lower Respiratory Disease Suicide Influenza and Pneumonia Nephritis, Nephrotic Syndrome, and Nephrosis

9. Total Enrollment of AI/AN in Schools for Selected Health Occupations According to Detailed Race, and Hispanic Origin: U.S. 2004-2005 Source: “Raising Awareness of American Indian/Alaska Native Health Issues.” Dean Seneca, MPH, MCURP (CDC)

10. Current CDC AI/AN Recruitment Rates 1/2 852 CDC employees hired in FY 07. Source: CDC Federal Agency Annual EEO Status Report FY2007

11. Current CDC AI/AN Recruitment Rates 2/2 CDC/ATSDR Employee Increase: July 1, 06 – March 1, 08 Source: “Raising Awareness of American Indian/Alaska Native Health Issues.” Dean Seneca, MPH, MCURP (CDC)

12. Surveys 1/2 Need to post job openings in a more effective manner to AI/AN; need a more targeted approach. Relationships need to be made between CDC and TCUs, tribal communities, & AI/AN orgs. AI/AN recruitment should begin at the high school age. Need for AI/AN internship/fellowship programs. Utilize current AI/AN employees to recruit AI/AN.

13. Surveys AI/AN employee incentives (scholar., loan reimb., etc.). Difficult for AI/AN to leave communities for Atlanta, need to establish AI/AN community support system. AI/AN employees need to provide each other with cultural support, & host events for non-AI/AN to learn. Offices working with AI/AN need better communication. 2/2

14. Challenges in working with AI/AN Communities Government networks overlook tribal governments and/or cultural protocol. Tribes often have a severe distrust of federal government & government employees. Tribal cultures and traditions may conflict with work expectations and procedures. Source: FEMA IS-650 Building Partnerships with Tribal Governments http://training.fema.gov/EMIWeb/IS/is650.asp

15. Tribal Communication Strategies Build honest relationships with the people. Ask the elders and tribal leaders for permission. Ask the elders and tribal leaders what is appropriate. Always work with the community. Work towards the benefit of their community. Be respectful. Any information that you collect from their community belongs to them. Source: ATSDR CDC http://www.atsdr.cdc.gov/tribal/understanding_issues_communities.html; FEMA IS-650 Building Partnerships with Tribal Governments http://training.fema.gov/EMIWeb/IS/is650.asp

16. AI/AN Common Values Source: ATSDR CDC http://www.atsdr.cdc.gov/tribal/understanding_issues_communities.html Respect: for the land, culture, community, family, elders. Sharing and Generosity, non-materialistic. Allegiance to family, community, and tribe. Group/Tribal Emphasis, Collectivistic. Extended family as important as nuclear family. A belief in an unseen power: the Great Spirit or Creator. Spirituality is intimately connected to health; reinforces relatedness of the individual, family, and community. Cooperation, Patience.

17. Differences Between Tribes Although AI/AN people are bound together by shared traditions and values, each tribe is different, with a unique history and culture. Each tribe may have a different leadership structure and protocol. It is very important that you research this information about the tribe before you visit. Tribal websites describe tribes and identify current leaders. Many tribes have publications that they will share upon request. Source: FEMA IS-650 Building Partnerships with Tribal Governments http://training.fema.gov/EMIWeb/IS/is650.asp

18. Some Sensitive Subjects Assumption that all tribal people are the same. Assumption that one AI/AN can represent their whole tribe or all AI/AN. Negative assumptions. Uneducated ideals. Unrightfully “claimed” AI/AN heritage. Use of inappropriate or non-preferable terms.

19. Suggestions 1/2 Build pipelines with AI/AN communities, TCU's, & colleges that have AI/AN students. Have an active presence at AI/AN communities, TCU's, & colleges. Utilize current AI/AN employees to speak with their own community people. Utilize CDC OMHD Tribal Consultation Advisory Committee (TCAC) & Senior Tribal Liaisons.

20. Start with high school students, give them CDC mentors & follow up with them through their education. Advertise CDC openings through IHS & tribal offices. Establish a social/cultural AI/AN community with current AI/AN employees. Have members of different tribes host different events. Have group put on social/ educational programs for CDC. Suggestions 2/2

21. Where to Recruit American Indian Higher Education Consortium (AIHEC) - Board of Directors is composed of 37 TCU’s. CDC Office of Minority Health & Health Disparities, National Indian Health Board (NIHB), Indian Health Services (IHS), National Council of Urban Indian Health (NCUIH). Colleges/Universities with AI/AN students, particularly in Alaska, Arizona, Montana, New Mexico, Oklahoma, & South Dakota. Assoc. of American Indian Physicians (AAIP), Assoc. of Native American Medical Students (ANAMS), National Alaska Native American Indian Nurses Assoc. (NANINA), American Indian Science & Engineering Society (AISES), Society for Advancement of Chicanos & Native Americans in Science (SACNAS), etc.

22. Lila Wopila!(Thank you!)

23. References American Indian & Alaska Native (AI/AN) Populations. Retrieved June 10, 2008, from Office of Minority Health and Health Disparities Web site: http://www.cdc.gov/omhd/Populations/AIAN/AIAN.htm#Disparities. Centers for Disease Control and Prevention. (2007). Equal Opportunity Program Federal Agency EEO Status Report (Fiscal Year 2007). Atlanta, GA: Office of Dispute Resolution and Equal Opportunity Employment. Centers for Disease Control and Prevention. (2008). Raising Awareness of American Indian/Alaska Native Health Issues [Brochure]. Atlanta, GA: Dean S. Seneca. Curry, J L The Wonderful Skyboat. Retrieved July 1, 2008, from Jane Louise Curry, Children's Books Author Web site: http://www.janelouisecurry.com/work8.htm. Health Disparities Affecting Minorities. Retrieved July 1, 2008, from CDC: Achieving Greater Health Impact Web site: http://www.cdc.gov/omhd/Brochures/PDFs/1PAIAN.pdf. IS-650 Building Partnerships with Tribal Governments. Retrieved July 1, 2008, from FEMA Emergency Management Institute Web site: http://training.fema.gov/EMIWeb/IS/is650.asp. The Influence of Indian Culture in the Cultures of the World. Retrieved July 1, 2008, from The Amauta Series Native American History Web site: http://www.xmission.com/~amauta/tribes.htm. (2003, Dec 15). Understanding American Indian/Alaska Native. Retrieved July 1, 2008, from Agency for Toxic Substances and Disease Registry Web site: http://www.atsdr.cdc.gov/tribal/understanding_issues_communities.html.

24. Questions?