Environmental Health in Indian Country: An exploration of working with tribes in the U.S.

1. Environmental Health in Indian Country: An exploration of working with tribes in the U.S. CDC/NCEH/ATSDR Office of Tribal Affairs Public Health Summer Fellow Internship Melinda M. Adams Mentor: Annabelle Allison

2. MSM PHSF Internship • 18 Minority students (6 Native American) • Stationed at Morehouse, Emory and CDC • Diverse educational backgrounds linked by public health • 4 days a week dedicated to job placement • Fridays reserved for course in Epidemiology/ public health

3. About the intern… • Albuquerque, NM • San Carlos Apache Tribe of Arizona • Recent Haskell Indian Nations University graduate • Bachelor of Science- Environmental Science/ Natural Resources • PhD Nutritional Epidemiology (Purdue University) • *Investigate health concerns within NA communities that stem from exposure to nutritional/ environmental contaminants

4. Benefits of a Tribal College/ University • Tradition/ Rich in history • Personalized attention to help overcome educational, economical and social barriers • Family-like atmosphere • Western education and traditional American Indian values • Encouraged to serve Indian Country!

5. Office of Tribal Affairs ‘ Helping American Indian and Alaska Native Nations strengthen their capacity to preserve the environment which is at the core of cultural identity and health’

6. NCEH Field and laboratory research to investigate effects of environment on health Surveillance Environmental emergency response Education & training ATSDR protect health & environment from hazardous substances Public Health assessment of waste sites Health consultations Health surveillance Registries Training/Outreach

7. NCEH/ATSDR • NCEH and ATSDR have defined a shared vision for environmental public health • Aims to establish common ground to build the national/international resources for addressing environmental public health threats • Promote health by improving the environment in which we live

9. Role of the OTA • Assist NCEH/ATSDR with requests from tribes for consultation/public health assessments • Works with external entities to fill data gaps within tribal communities • Internal collaboration in solving health issues • Builds bridges between environmental health and environmental protection in Indian Country • Main point of contact

10. Hopi Reservation pesticides health assessment Tohono o’ Odham emergency response capabilities Squaxin Island Tribes of Puget fish consumption survey Port Graham Village council research protocol Tar Creek superfund site work on lead Alaska FUDs Navajo Nation Youth Risk Behavior Survey Salish/ Kootenai decrease in Methamphetamine laboratories College of Menominee Nation building environmental public health capacity Navajo Nation dip vats Public Health consultation Confederate tribes of Colville public health assessment/ petition procedure St. Regis Mohawk tribe PCB research Mold and moisture conditions in Native American housing Environmental health plan proposal tribes impacted by Hanford Nuclear reservation Historic OTA Projects (2004)

11. Current OTA Projects – Summer 2008 • Lummi Nation Specific Fish Consumption Survey • Sisseton Sioux Nation concerns on Mold Issues • Yurok nation of California wildfires • Strategic development of current and future activities *Health and environmental impacts of Uranium contamination in the Navajo Nation * Native American Environmental Health Research Initiative

12. In 1944-1986 4M tons of Uranium extracted in the Navajo Nation. Left the Navajo with a legacy of Over 500 abandoned uranium mines (AUM’s), 4 inactive uranium milling sites, 1 former dump site, Contaminated ground water, Structures that contain elevated levels of radiation March 2008 - 5 year plan as requested by House Committee on oversight and government reform Project 1: Navajo Uranium Mining • House committee asked BIA, DOE, NRC, EPA and IHS to develop a coordinated plan to address: • Assessment of contaminated water sources • Cleanup of contaminated sites • Alternate water supplies • Assessment of AUM’s • Case controlled studies of health risks

13. Role of NCEH/ ATSDR Waxman committee requested brief on: Endeavors related to uranium contamination of water supplies on Navajo land including: • Projects NCEH/ ATSDR have done to date • Plans for future work • MOU’S with BIA where activities and funding can be executed • Other ways the agencies can contribute to the future • Staff expertise (assessment/evaluation of contamination)

14. Project 2: Native American Environmental Health Research Initiative • Yu’pik Eskimo/ Athabascans • High exposure to POPs • Elevated incidence of chronic disease • Diabetes, Colon cancer • Coordinate analytical studies for POP evaluation • University/ State partners (leverage resources to greatest extent)

15. Role of OTA • Establish contacts within the Alaska Native American villages that are susceptible to health disparities • Chemical exposure through hunting and fishing subsistence. • Exchange information with Tribal environmental workgroups • Make site-specific visits in order to review the policy and procedure that is necessary for investigation

16. Project 3: Ambient air pollution in Children with sickle cell • NCEH Air Pollution and Respiratory Health branch • Ambient air pollution associated with increase risk of respiratory complications • Goal: Determine if ambient concentration of air pollutants in Atlanta, GA are associated with adverse health effects in children with SCD

17. Role of the Intern • Create survey database • data entry design and structure management • Field equipment training session attendance • gain knowledge of state of the art monitoring instrumentation • accurate collection of respiratory health measurements. • Explore the collaboration of OTA and other ATSDR branches • Air Pollution and Respiratory Health

18. Training Session

19. Future OTA Projects • Bridge the gap between Environmental concerns and environmental health • Training programs for working in Indian Country • Continued education around traditional ways of life through a Native perspective • Develop tribal-specific health models • Support in interpreting/ sharing data • Increase Staff/ Budget

20. Recommendations for the future • Locations in addition to Atlanta • Survey tribal public health needs on a national scale • Strengthen alliances • Advocate for funding and programs • Tribal College/ University outreach • Conduct evaluations of OTA

21. Take home lessons - OTA • Essential role – Tribal environmental/ Health issues • Speaks for both parties • Trust between agencies and tribe • People who are enthusiastic and understanding about culture • Recognize significance of Native American perspective and input on environmental issues • Career opportunities/ serving the community

22. Thank you!

23. References • Agency for health care Policy and Research. Sickle cell disease. Screening, diagnosis, management and in new born and infants. Clinical Practice Guideline. Rockville, MD: Agency for health care Policy an Research, 1993. Publication 93-0562 • Report on the expert panel to evaluate ATSDR’s Office of Tribal Affairs. Prepared by the Agency for Toxic Substance and Disease Registry. ERG Lexington, MA. 2007 • http://www.atsdr.cdc.gov/HAC/PHAmanual/ch2.html