Norma Thomas, a resident of Owyhee on the Duck Valley Indian Reservation, talks with David Simons, a doctor at the Shoshone-Paiute Tribes Owyhee Community Health Facility in Nevada on Nov. 25, 2013. (Darin Oswald for The Washington Post)
After decades of underfunding hundreds of contracts with Native Americans, the federal government over the past several months has reached settlement agreements on 146 claims, totalling $275 million, government records show.
The settlements for health and social service contracts represent about 10 percent of all outstanding tribal claims with the federal Indian Health Service. The unpaid contract expenses were the subject of two U.S. Supreme Court rulings, the latest in June 2012, in which both IHS and the Bureau of Indian Affairs (BIA) were ordered to pay outstanding claims on the self-determination contracts.
The disputed contracts have their origins in the 1975 Indian Self-Determination Act, which gives tribes the option of receiving federal funding to run their own education, public safety and health-care programs. Those services — which were promised in perpetuity in tribal treaties — historically were delivered by the IHS and BIA.
The unpaid claims are for “contract support costs,” which include travel expenses, legal and accounting fees, insurance costs and workers’ compensation fees. Such costs typically account for between 10 to 20 percent of the value of a contract.
“The federal government has a trust responsibility to provide health care for this nation’s First Peoples and it’s about time it steps up to pay legal and contractual obligations to those tribes that choose to take over this responsibility through self-governance contracts and compacts,” Sen. Mark Begich (D-Alaska) said in a prepared statement.
Through letters and public hearings, Begich and several other members of Congress have pressured IHS and BIA to resolve past unpaid claims since the last Supreme Court ruling nearly two years ago.
IHS is working through thousands of disputed claims in more than 200 lawsuits filed by tribes, which are being individually negotiated. BIA is dealing with a single class-action lawsuit, which includes unpaid claims for hundreds of tribes, which has not yet been resolved.
The largest IHS settlement of $96 million went to Southcentral Foundation in Anchorage. The organization operates several health-care facilities, including a portion of the Alaska Native Medical Center, and serves more than 60,000 Alaska Natives and American Indians.
Llloyd Miller, an attorney in the Supreme Court cases, who is also representing 55 tribes in the settlement talks, said progress is being made, but at the current pace it would take IHS another three years to resolve all outstanding claims.
“It’s an enormous breakthrough because, over the past two years, little in the way of settlements have been achieved,” Miller said. “The challenge for the agency is to resolve the remaining 90 percent in a coherent time frame.”
In February, both agencies committed for the first time in decades to fully fund the self-determination contracts in their 2014 revised budgets. The revisions followed a Washington Post article in December that detailed the administration’s plans to impose spending caps on the contracts, despite two U.S. Supreme Court rulings ordering the government to fully compensate the tribes.
Federal contractors have carefully monitored the case because they worried that if federal agencies were able to not pay contract support costs for tribes, it could set a dangerous precedent for non-tribal service contracts with federal agencies.
In a friend-of-the-court brief to the Supreme Court in 2012, the U.S. Chamber of Commerce said: “The government’s position would have the effect of making contracts illusory by giving it a broad right to refuse payment at the stated price for services rendered.”
FLAGSTAFF, Ariz. (AP) – Facing a high prevalence of diabetes, many American Indian tribes are returning to their roots with community and home gardens, cooking classes that incorporate traditional foods, and running programs to encourage healthy lifestyles.
The latest effort on the Navajo Nation, the country’s largest reservation, is to use the tax system to spur people to ditch junk food.
A proposed 2 percent sales tax on chips, cookies and sodas failed Tuesday in a Tribal Council vote. But the measure still has widespread support, and advocates plan to revive it, with the hope of making the tribe one of the first governments to enact a junk-food tax.
Elected officials across the U.S. have taken aim at sugary drinks with proposed bans, size limits, tax hikes and warning labels, though their efforts have not gained widespread traction. In Mexico, lawmakers approved a junk food tax and a tax on soft drinks last year as part of that government’s campaign to fight obesity.
Navajo President Ben Shelly earlier this year vetoed measures to establish a junk-food tax and eliminate the tax on fresh fruit and vegetables. At Tuesday’s meeting, tribal lawmakers overturned the veto on the tax cut, but a vote to secure the junk-food tax fell short. Lawmakers voted 13-7 in favor of it, but the tax needed 16 votes to pass.
The Dine Community Advocacy Alliance, which led the effort, said it plans to revise the proposal and bring it before lawmakers again during the summer legislative session.
“We’re going to keep moving on it,’’ group member Gloria Begay said. “It’s not so much the tax money – it’s the message. The message being, ‘Let’s look at our health and make healthier choices.’ We have to go out and do more education awareness.’’
Shelly said he supports the proposal’s intent but questioned how the higher tax on snacks high in fat, sugar and salt would be enacted and regulated. Supporters say the tax is another tool in their fight for the health of the people.
“If we can encourage our people to make healthier choices and work on the prevention side, we increase the life span of our children, we improve their quality of life,’’ said professional golfer Notah Begay III, who is among supporters.
American Indians and Alaska Natives as a whole have the highest age-adjusted prevalence of diabetes among U.S. racial and ethnic groups, according to the American Diabetes Association. They are more than twice as likely as non-Hispanic whites to have the disease that was the fourth leading cause of death in the Navajo area from 2003 to 2005, according to the Indian Health Service.
Native children ages 10 to 19 are nine times as likely to be diagnosed with Type 2 diabetes, the IHS said.
The proposed Navajo Nation tax wouldn’t have added significantly to the price of junk food, but buying food on the reservation presents obstacles that don’t exist in most of urban America. The reservation is a vast 27,000 square miles with few grocery stores and a population with an unemployment rate of around 50 percent. Thousands of people live without electricity and have no way of storing perishable food items for too long.
“They have a tendency to purchase what’s available, and it’s not always the best food,’’ said Leslie Wheelock, director of tribal relations for the U.S. Department of Agriculture.
Wheelock said the diabetes issue in tribal communities is one that has been overlooked in the past or not taken as seriously as it could be. It has roots in the federal government taking over American Indian lands and introducing food that tribal members weren’t used to, she said.
To help remedy that, the USDA runs a program that distributes nutritional food to 276 tribes. Grants from the agency have gone toward gardening lessons for children within the Seneca Nation of Indians in New York, culturally relevant exercise programs for the Spirit Lake Tribe in North Dakota and food demonstrations using fresh fruit and vegetables on the Zuni reservations in New Mexico.
The Dine Community Advocacy Alliance estimated a junk-food tax would result in at least $1 million a year in revenue that could go toward wellness centers, community parks, walking trails and picnic grounds in Navajo communities in Utah, New Mexico and Arizona. It would have expired at the end of 2018.
No other sales tax on the Navajo Nation specifically targets the spending habits of consumers. Alcohol is sold in a few places on the reservation but isn’t taxed. Retailers and distributors pay a tobacco tax.
Opponents of the junk food tax argued it would burden customers and drive revenue off the reservation. Mike Gardner, executive director of the Arizona Beverage Association, said the lack of specifics in the legislation as to what exactly would be taxed could mean fruit juice and nutritional shakes could be lumped in the same category as sodas.
“I don’t think they mean that, but that’s what will happen,’’ Gardner said. “It’s a little loose, a little vague. It’s going to create problems for retailers and … it doesn’t solve the problem.’’
The multibillion-dollar e-cigarette industry is not regulated, but the Food and Drug Administration is seeking to change that. Credit Frank Franklin II/Associated Press
WASHINGTON — The Food and Drug Administration will propose sweeping new rules on Thursday that for the first time would extend its regulatory authority from cigarettes to electronic cigarettes, popular nicotine delivery devices that have grown into a multibillion-dollar business with virtually no federal oversight or protections for American consumers.
The regulatory blueprint, with broad implications for public health, the tobacco industry and the nation’s 42 million smokers, would also cover pipe tobacco and cigars, tobacco products that have long slid under the regulatory radar and whose use has risen sharply in recent years. The new regulations would ban the sale of e-cigarettes, cigars and pipe tobacco to Americans under 18, and would require that people buying them show photo identification to prove their age, measures already mandated in a number of states.
Once finalized, the regulations will establish oversight of what has been a market free-for-all of products, including vials of liquid nicotine of varying quality and unknown provenance. It has taken the agency four years since Congress passed a major tobacco-control law in 2009 to get to this stage, and federal officials and advocates say it will take at least another year for the rules to take effect — and possibly significantly longer if affected companies sue to block them.
“If it takes more than a year to finalize this rule, the F.D.A. isn’t doing its job,” said Matthew Myers, president of the Campaign for Tobacco-Free Kids, an advocacy group.
Thursday’s release of the blueprint — which is hundreds of pages long — is sure to set off a frantic lobbying effort in Washington as affected industries try to head off the costliest, most restrictive regulations.
Members of the Smoke Free Alternatives Trade Association, one of the e-cigarette industry trade groups, descended on Washington in November, and reported holding nearly 50 meetings with congressional officials to help them “learn more about the negative impact inappropriate regulation could have on this nascent industry,” the group said in a statement.
The industry has several trade associations, and a number of them have met with Obama administration officials about the regulations over the past several months, according to public records and industry group statements.
F.D.A. officials gave journalists an outline of the new rules on Wednesday, but required that they not talk to industry or public health groups until after Thursday’s formal release of the document.
The agency said the 2009 law gave it the power to prohibit sales to minors of all tobacco products that it has authority over, which now will include e-cigarettes and cigars. A spokeswoman said the move did not reflect a finding about the safety of these products.
Perhaps the biggest proposed change would require producers of cigars and e-cigarettes to register with the F.D.A., provide the agency with a detailed accounting of their products’ ingredients and disclose their manufacturing processes and scientific data. Producers would also be subject to F.D.A. inspections.
But the new blueprint was also notable for what it did not contain: any proposal to ban flavors in e-cigarettes and cigars, like bubble gum and grape, that public health experts say lure children to use the products, or any move to restrict the marketing of e-cigarettes, as is done for traditional cigarettes, which are banned from television, for example.
F.D.A. officials said the new regulations were the first major step toward asserting the agency’s authority and eventually being able to regulate flavors and marketing. But doing so will require further federal rulemaking, they said.
For example, to restrict the use of flavors, the agency would have to establish a factual record that they pose a health risk for young people. The same goes for marketing, an area that has been vulnerable to litigation from industry. The agency tried to impose graphic warning labels on cigarette packaging, for example, only to have tobacco companies fight the measure in court and win on grounds that it violated their First Amendment right to free speech.
“You can’t get to the flavors until you have regulatory authority over them,” said Mitchell Zeller, director of the Center for Tobacco Products at the F.D.A. He called the blueprint “foundational.”
The regulations establish federal authority over tobacco products that were not named in the 2009 tobacco control law, including certain dissolvable tobacco products, water pipe tobacco and nicotine gels. E-cigarettes are considered a tobacco product because their main ingredient, nicotine, is derived from tobacco.
One exception is sure to worry antismoking activists: Mr. Zeller said the agency was asking for public comment on whether premium cigars — hand-rolled with a tobacco leaf as a wrapper — should be placed in a special separate category not subject to F.D.A. authority. The cigar industry has lobbied Congress furiously for exemption to the rules, garnering some support from both Democrats and Republicans.
The new regulatory proposal is open to public comment for 75 days, and then the agency will make final changes, a process that will take months.
Under the new rules, companies would no longer be able to offer free samples, and e-cigarettes would have to come with warning labels saying that they contain nicotine, which is addictive. Companies would also not be able to assert that e-cigarettes were less harmful than real cigarettes unless they got approval from the F.D.A. to do so by submitting scientific information.
In the proposed restrictions on sales to minors, vending machines in public places where minors are allowed would no longer be able to carry them. A ban on Internet sales to minors, already in place for cigarettes, would extend to e-cigarettes and cigars.
E-cigarette consumption is rising fast, and in the absence of federal regulations, many states have already passed laws that ban e-cigarettes from public places, regulate their sale, and in some cases tax them. More than half of states already enforce bans on their sale to minors.
Under the new rules, companies would have to apply for F.D.A. approval for their products, but would have two years after the new rules are finalized to do so. Companies can keep their products on the market in the meantime. Eventually, the companies would have to adhere to F.D.A. standards for manufacturing their products, not unlike how drug companies and food companies do now, but the agency has yet to write those rules.
Some experts have cautioned that too high a regulatory bar could stifle smaller e-cigarette producers and help deep-pocketed tobacco companies, which have also gotten into the e-cigarette business. Innovation to make e-cigarettes better would also slow if regulations were too burdensome, they say. Meeting such requirements includes the expenses of application costs, user fees that industry pays the agency, and assembling a scientific case to show that a product should be approved.
Bonnie Herzog, an analyst at Wells Fargo Securities in New York, said the proposal would probably lead to consolidation in the fragmented e-cigarette industry, where there are now around 200 manufacturers.
“It benefits the entrenched players,” she said, referring to the three big tobacco companies that produce e-cigarettes, Lorillard, R.J. Reynolds and Altria, the parent company of Philip Morris U.S.A., as well as larger e-cigarette producers, like Njoy and Logic.
Health experts disagree over the role of e-cigarettes, with some arguing that they offer the first real alternative to the deadly risks of smoking and could save millions of lives. Others are more cautious, saying their gadgetry and flavors tempt children, and that people are using them to enable smoking habits, not to quit.
Antismoking activists say the agency must strike a balance.
“In the urgency not to stifle innovation, we shouldn’t eliminate the need for scientific evidence,” Mr. Myers said. “You can’t let them be fly-by-night operations.”
New research from the U.S. Geological Survey shows some fish in the West’s pristine, alpine lakes like Lake Solitude in Grand Teton National Park (pictured here) have high mercury levels. | credit: U.S. Geological Survey/John Pritz | rollover image for more
SEATTLE — Some bad news for backcountry in the West: Some of the fish in the region’s wild alpine lakes contain unsafe levels of mercury, according to a new study by the U.S. Geological Survey.
In the broadest study of its kind to date, the USGS tested various kinds of trout and other fish at 86 sites in national parks in 10 western states from 2008 to 2012. The average concentration of mercury in sport fish from two sites in Alaskan parks exceeded federal health standards, as did individual fish caught in California, Colorado, Washington and Wyoming.
But perhaps more importantly, mercury was detected in all of the fish sampled, even from the more pristine areas of the parks.
The study, conducted jointly by the National Park Service and the USGS, found that mercury levels varied greatly from park to park and even among sites within each park. Overall, 96 percent of the sport fish sampled were within safe levels of mercury for human consumption.
“It’s good news that across this entire study area most of the fish were low,” said Collin Eagles-Smith, a research ecologist with USGS and the lead author of the study. “The concern is that there were some areas, and some fish, that did have concentrations that might pose a threat to either wildlife or humans.”
Spatial distribution of the 21 national parks sampled in this
study. Size of circle represents percentage of total dataset.
Credit: USGS.
Two percent of the fish sampled in Mount Rainier National Park exceeded the Environmental Protection Agency’s guidelines for safe human consumption. Fish sampled in Olympic National Park had a higher average mercury concentration than some other parks in the region, but none of the samples were above safe human consumption levels.
“Mercury concentrations in those fish in the Pacific Northwest were quite variable,” Eagles-Smith said. “Crater Lake had quite low concentrations in comparison to other parks, whereas Olympic National Park had some of the highest concentrations in comparison to other parks.”
The researchers were surprised to find some of the highest levels of mercury in a small fish called the speckled dace, which were sampled in Capitol Reef and Zion national parks in Utah.
“The concentrations in those fish were comparable to the highest concentrations we saw in the largest, longlived fish in Alaska,” Eagles-Smith said. He added that more research is needed to better understand how mercury is deposited from the atmosphere into the environment and then concentrated at varying levels in different species.
Speckled dace
There was some bad news in the study for birds: In more than half the sites tested, fish had mercury levels that exceeded the most sensitive health benchmark for fish-eating birds, Eagles-Smith said.
“People can regulate their intake of fish and wild fish-eating birds can’t. So, they’re going to take in more fish and more mercury as a result, and it can impact their behavior, ability to reproduce and ability to find food.”
Mercury can come from natural sources, like volcanoes. However, since the industrial revolution atmospheric mercury levels have increased three-fold because of the burning of fossil fuels. Recent studies have shown that particulate pollution from China, which could result from the burning of coal among other sources, can and does make its way across the Pacific Ocean to North America.
The Centers for Disease Control and Prevention warns that exposure to high levels of mercury in humans may cause damage to the brain, kidneys and the developing fetus. Pregnant women and young children are particularly sensitive to the effects of mercury.
From left, Team 4 Dave members Dennis, Chris and Sarah Coerber round the corner of the final stretch of the Walk MS in Tulalip on April 12. — image credit: Kirk Boxleitner
TULALIP — Nearly 600 walkers started and ended their course at the Tulalip Amphitheatre for this year’s Walk MS in Tulalip on Saturday, April 12, and while this represented a slightly smaller turnout than last year’s local event, event organizers still considered it a healthy show of support given the other worthy causes close to home that are calling for people’s time and commitment.
“We understand the community is splitting its attention, with the recent tragedy in Oso,” said Sarah Chromy, communications manager for the National Multiple Sclerosis Society’s Greater Northwest Chapter. “It’s still an impressive number for Snohomish County.”
As of Tuesday, April 15, Chromy estimated that the Walk MS in Tulalip had generated nearly $90,000 for the National MS Society in Snohomish County, out of the $1.6 million in funds raised through this year’s Walk MS events throughout the Greater Northwest Chapter. These numbers are actually up from last year’s.
“The Lumpy Bruisers, with team captain Mitzi Ahles, did an amazing job of recruiting and fundraising this year,” Chromy said. “The Snohomish Goat Farmers, with team captain Ray Emery, led the way as our highest local fundraising team, with more than $16,000. Plus, they always bring out at least two goats to Walk MS, which is a sure crowd-pleaser for the children.”
The Mel Walkers team, with joint captains Bruce and Melissa Groenewegen, ranked second in fundraising, with more than $15,000, while Elaine’s Power Walkers, with team captain Jeff Ponton, came in third with more than $4,000.
“Elaine’s Power Walkers also brought tons of team spirit and balloons,” Chromy said. “The face painter was a big hit as well, painting everything from birds to tigers, and everything in between.”
Chromy explained that more than 77 cents of every dollar raised through Walk MS goes directly to improve the lives of people living with MS. Through its donors and fundraisers, the National MS Society is able to:
Fund cutting-edge research to stop MS, restore lost functions and end MS forever.
Drive change through advocacy.
Facilitate professional education.
Collaborate with MS organizations around the world.
Provide programs and services that help people with MS and their families move forward with their lives.
“Last year, it was pouring rain out here, so everyone was happy to hang around after this year’s Walk MS to catch up with one another, have some lunch and soak up some sunshine,” Chromy said. “Walk MS connects those in our local communities to one another, as we rally together to raise funds and celebrate hope for a future free of multiple sclerosis. It’s an opportunity for everyone affected by MS to meet others who may be going through similar life experiences, and to take action to end MS forever. There’s an incredible network of support, information and resources available, and Walk MS is the rallying point that makes it all possible.”
A patient gets more information about a colonoscopy from his provider at the Alaska Native Medical Center. Photo is courtesy of the Alaska Native Tribal Health Consortium.
Source: CDC Media Relations, April 22, 2014
Death records show that American Indian and Alaska Native (AI/AN) death rates for both men and women combined were nearly 50 percent greater than rates among non-Hispanic whites during 1999-2009. The new findings were announced through a series of CDC reports released online today by the American Journal of Public Health.
Correct reporting of AI/AN death rates has been a persistent challenge for public health experts. Previous studies showed that nearly 30 percent of AI/AN persons who identify themselves as AI/AN when living are classified as another race at the time of death.
“Accurate classification of race and ethnicity is extremely important to addressing the public health challenges in our nation, said Ursula Bauer, Ph.D., M.P.H., director of CDC’s National Center for Chronic Disease Prevention and Health Promotion. “We must use this new information to implement interventions and create changes that will reduce and eliminate the persistent inequalities in health status and health care among American Indians and Alaska Natives.”
CDC’s Division of Cancer Prevention and Control led the project and collaborated with CDC’s National Center for Health Statistics and other CDC researchers, the Indian Health Service, partners from tribal groups, universities, and state health departments.
Key findings:
·Among AI/AN people, cancer is the leading cause of death followed by heart disease. Among other races, it is the opposite.
·Death rates from lung cancer have shown little improvement in AI/AN populations. AI/AN people have the highest prevalence of tobacco use of any population in the United States.
·Deaths from injuries were higher among AI/AN people compared to non-Hispanic whites.
·Suicide rates were nearly 50 percent higher for AI/AN people compared to non-Hispanic whites, and more frequent among AI/AN males and persons younger than age 25.
·Death rates from motor vehicle crashes, poisoning, and falls were two times higher among AI/AN people than for non-Hispanic whites.
·Death rates were higher among AI/AN infants compared to non-Hispanic whites infants. Sudden infant death syndrome and unintentional injuries were more common. AI/AN infants were four times more likely to die from pneumonia and influenza.
·By region, the greatest death rates were in the Northern Plains and Southern Plains. The lowest death rates were in the East and the Southwest.
“The new detailed examination of death records offers the most accurate and current information available on deaths among the American Indian and Alaska Native populations,” said David Espey, M.D., acting director of CDC’s Division of Cancer Prevention and Control. “Now, we can better characterize and track the health status of these populations – a critical step to address health disparities.”
The studies address race misclassification in two ways. First, the authors linked U.S. National Death Index records with Indian Health Services registration records to more accurately identify the race of AI/AN people who had died. Second, the authors focused their analyses on the Indian Health Services’ Contract Health Service Delivery Area counties (CHSDA) where about 64 percent of AI/AN persons live. Fewer race misclassification errors occur in CHSDA data than in death records.
The authors reviewed trends from 1990 through 2009, and compared death rates between AI/AN people and non-Hispanic whites by geographic regions for a more recent time period (1999-2009).
The report concludes that patterns of mortality are strongly influenced by the high incidence of diabetes, smoking prevalence, problem drinking, and health-harming social determinants. Many of the observed excess deaths can be addressed through evidence-based public health interventions.
“The Indian Health Service is grateful for this important research and encouraged about its potential to help guide efforts to improve health and wellness among American Indians and Alaska Natives,” said Yvette Roubideaux, M.D., M.P.H, acting IHS director. “Having more accurate data along with our understanding of the contributing social factors can lead to more aggressive public health interventions that we know can make a difference.”
The Affordable Care Act (ACA), also known as the health care law, was created to expand access to coverage, control health care costs, and improve health care quality and coordination. The ACA also includes permanent reauthorization of the Indian Health Care Improvement Act, which extends current law and authorizes new programs and services within the Indian Health Service. Visit Healthcare.gov or call 1-800-318-2596 (TTY/TDD 1-855-889-4325) to learn more.
WASHINGTON — The government is taking a step to let friends or loved ones treat someone they suspect has overdosed on heroin or powerful painkillers called opioids, while they’re waiting for medical care.
The Food and Drug Administration on Thursday approved an overdose antidote that doctors could prescribe for family members or caregivers to keep on hand, in a pocket or a medicine cabinet. Called Evzio, it’s a device that automatically injects the right dose of the drug naloxone, a long-used antidote for opioid overdoses.
Naloxone is usually administered by syringe in ambulances or emergency rooms. But with the rise in drug overdose deaths, there has been a growing push to equip more people with the protection.
The FDA said Evzio’s design makes it easy for anyone to administer. Once Evzio is turned on, it provides verbal instructions, much like defibrillators that laymen frequently use to help people who collapse with cardiac arrest.
The antidote is not a substitute for immediate medical care, the FDA said, as anyone who has overdosed will need additional treatment.
FDA Commissioner Margaret Hamburg said in a statement that 16,000 people die every year due to opioid-related overdoses, and that drug overdose deaths are now the leading cause of injury death in the United States, surpassing motor vehicle crashes. She said the increase in overdose deaths has largely been driven by prescription drug overdoses.
“While the larger goal is to reduce the need for products like these by preventing opioid addiction and abuse, they are extremely important innovations that will help to save lives,” Hamburg said.
Follow Mary Clare Jalonick on Twitter: http://twitter.com/mcjalonick
A big measles outbreak in British Columbia has crossed over the border into the American Northwest.
Health officers in B.C.’s Fraser Valley have confirmed over 350 cases of measles there since an outbreak started in early March. Six additional cases have now been diagnosed in Whatcom County, Wash., including a woman in her 20s who has prompted a regionwide alert.
While contagious, she mingled with crowds at a rock concert at Seattle’s Key Arena. She also visited Puget Sound tourist attractions such as the Pike Place Market, LeMay Car Museum and Harmon Brewing Company in Tacoma.
Whatcom County Health Officer Greg Stern says this measles outbreak traces back to a religious community in British Columbia’s “Bible Belt.”
“To the extent that people avoid vaccines, they increase both their risk and the risk of the community so that it can take hold. I’m worried about that.”
Already this year, seven cases of measles have been reported to the Washington State Department of Health. That compares to just five over the entire course of last year.
In recent years, the Washington and Oregon legislatures have made it harder to get vaccination exemptions for school-age children.
A two day conference allows a newly created organization to demonstrate its work and research on various health-related issues facing Native Americans in the United States. The sixth annual Tribal Epidemiology Center Public Health Conference’s theme isWhere We Have Been, Where We Are, And Where We Are Going.
Where We Have Been
In the mid 1990’s, Native American tribes saw the need to write their own health stories and maintain their own data banks on health statistics. Funding from the Indian Health Service helped to create the first two epidemiology pilot centers, or EPI Centers.
In 2004, the Oklahoma City area received similar funding to create what is one of twelve centers currently serving the United States’ indigenous population.
Where We Are Now
Tyler Snyder is the epidemiologist at the Tribal Epidemiology Center in Oklahoma City. Snyder says this center is not just about a traditional view of epidemiology.
“What we do here, instead of doing just disease outbreak and surveillance, we provide EPI services in the form of helping people develop surveys, implement the surveys, doing analysis and we also provide training, like tobacco cessation training, intervention training, and training on a number of other health issues,” said Snyder.
“We also provide some community health profiling,” Snyder said. “We look at data from the national level, state level and also some locally collected data and put those together to form a picture for a tribe so we can say ‘here’s what your tribe’s health looks like right now.’
Dr. Tom Anderson (Cherokee), is the director of the so-called EPI Center in Oklahoma City. Anderson said part of the Affordable Care Act reauthorizes the Indian Health Care Improvement Act, and sets some specific goals.
“Tribal epidemiology centers are to be considered as public health authorities for the area tribes,” Anderson said. “The EPI centers were to carry out seven specific functions including disease surveillance, data collections, evaluation of delivery systems, assist tribes in identifying highest priority health status, recommendations for targeting services, and so on.”
Where We Are Going
Patricia Yarholar (Sac and Fox) is the public health coordinator at The Tribal Epidemiology Center. Yarholar sees the conference as a way to implement some of those directives. The two day conference will hold several behavioral workshops and suicide prevention workshops imbued with native sensibilities.
“We also have the health policy track, we’re going to be having a workshop on incorporating taking culture into policy. Making tribal health programs and employees work with American Indians so it will be culturally appropriate information,” Yarholar said.
“A workshop on accreditation for public health as well as another one on the tribal public health institute is very new and I think a lot of people will be very interested in what this workshop has to share with us,” Yarholar said.
“What it does is reach out to tribes and provides market analysis, organizational and financial analysis in working with Native American tribes,” Yarholar said. “An assessment to determine needs and the potential role that the tribal health public institute has in order to go along the line of organizational structure, and operating costs can be done.”
The AARP will be holding a round table on transportation.
“This relates to a lot of the health disparities people experience because they don’t have transportation to go to appointments or maybe to go to different areas to pick up medication or to pick up proper foods,” Yarholar said.
Other workshops will go over the Affordable Health Care Act, the Health Insurance Marketplace, diabetes in Cherokee children and diabetes in the Kickapoo tribe.
Keynote speakers include Michael Bird(Santa Domingo/San Juan Pueblo), the first Native American to serve as president of the American Public Health Association, and Dr. Jessica Rickerts(Prairie Band Potawatomi), the first female Native American dentist. Rickerts will present a workshop on the dental health of American Indian/Alaska Native Veterans
The 6th Annual Tribal Epidemiology Center Public Health Conference takes place April 29 & 30 in the Fire Lake Grand Casino in Shawnee and is free and open to the public.
