Download Public Health Law and Science: A Seminar for Judges

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
American Public Health System
2
3
Surveillance of Infectious Diseases Among
American Indians/ AK Natives Bertolli et al, 2008
4
Case reported to
state/county agencies
IHS (%)
n=45/68
2001
Tribal / Urban (%)
n = 66/120
2004
HIV/AIDS
96
67
STDs
98
71
Hepatitis A
93
62
Hepatitis B
93
65
Hepatitis C
91
67
Tuberculosis
96
71
Surveillance of Infectious Diseases Among
American Indians/ AK Natives
Bertolli
et
al,
2008
5
Received state/ county
surveillance report
IHS (%)
n=45/68
2001
Tribal / Urban (%)
n = 66/120
2004
HIV/AIDS
29
29/16
STDs
37
27/12
Hepatitis A
35
27/12
Hepatitis B
33
23/11
Hepatitis C
32
23/11
Tuberculosis
32
21/11
Multistate Assessment of Public Surveillance
Relevant to AI/ AN, 2007, Bertolli et al 2011
6
 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
7
Public Health
8
“ 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".
Science 51 (1306): 23–33. doi:10.1126/science.51.1306.23. PMID 17838891.
Public Health Approach
Public Health
Model
Versus
Medical
Model
Public Health Ten Essential Services
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1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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
Need for Integration of Tribal Nations into American Public Health System,
Reportable Disease Surveillance System
11
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
Need for Integration of Tribal Nations into American Public Health System,
Reportable Disease Surveillance System
12
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
Need for Integration of Tribal Nations into American Public Health System,
Reportable Disease Surveillance System
13
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
Acknowledgements
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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
. Prevention Public Health Law Program
from the Centers for Disease Control and
through a sub-award from the Association
of State and Territorial Health Officials