environmental health in indian country: an exploration of working with tribes in the u.s....
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Environmental Health in Indian Environmental Health in Indian Country: An exploration of Country: An exploration of
working with tribes in the U.S.working with tribes in the U.S.
CDC/NCEH/ATSDRCDC/NCEH/ATSDR
Office of Tribal AffairsOffice of Tribal Affairs
Public Health Summer Fellow Public Health Summer Fellow InternshipInternship
Melinda M. AdamsMelinda M. AdamsMentor: Annabelle AllisonMentor: Annabelle Allison
MSM PHSF InternshipMSM PHSF Internship 18 Minority students (6 Native American)18 Minority students (6 Native American) Stationed at Morehouse, Emory and CDCStationed at Morehouse, Emory and CDC Diverse educational backgrounds linked by Diverse educational backgrounds linked by
public healthpublic health 4 days a week dedicated to job placement4 days a week dedicated to job placement Fridays reserved for course in Fridays reserved for course in
Epidemiology/ public healthEpidemiology/ public health
About the intern…About the intern… Albuquerque, NMAlbuquerque, NM San Carlos Apache Tribe of ArizonaSan Carlos Apache Tribe of Arizona Recent Haskell Indian Nations University Recent Haskell Indian Nations University
graduategraduate Bachelor of Science- Environmental Science/ Bachelor of Science- Environmental Science/
Natural Resources Natural Resources PhD Nutritional Epidemiology (Purdue PhD Nutritional Epidemiology (Purdue
University)University) *Investigate health concerns within NA *Investigate health concerns within NA
communities that stem from exposure to communities that stem from exposure to nutritional/ environmental contaminantsnutritional/ environmental contaminants
Tradition/ Rich in historyTradition/ Rich in history Personalized attention to help Personalized attention to help
overcome educational, economical and overcome educational, economical and social barrierssocial barriers
Family-like atmosphere Family-like atmosphere Western education and traditional Western education and traditional
American Indian values American Indian values Encouraged to serve Indian Country!Encouraged to serve Indian Country!
Benefits of a Benefits of a Tribal College/ Tribal College/
UniversityUniversity
Office of Tribal AffairsOffice of Tribal Affairs‘ ‘ Helping American Indian and Alaska Helping American Indian and Alaska
Native Nations strengthen their Native Nations strengthen their capacity to preserve the capacity to preserve the
environment which is at the core of environment which is at the core of cultural identity and health’cultural identity and health’
NCEHNCEH Field and laboratory Field and laboratory
research to research to investigate effects of investigate effects of environment on environment on healthhealth
SurveillanceSurveillance Environmental Environmental
emergency responseemergency response Education & Education &
trainingtraining
ATSDRATSDR protect health & protect health &
environment from environment from hazardous hazardous substancessubstances
Public Health Public Health assessment of assessment of waste siteswaste sites
Health Health consultationsconsultations
Health Health surveillancesurveillance
RegistriesRegistries Training/OutreachTraining/Outreach
NCEH/ATSDR NCEH/ATSDR
NCEH and ATSDR have defined a NCEH and ATSDR have defined a shared vision for environmental shared vision for environmental public healthpublic health
Aims to establish common ground to Aims to establish common ground to build the national/international build the national/international resources for addressing resources for addressing environmental public health threatsenvironmental public health threats
Promote health by improving the Promote health by improving the environment in which we liveenvironment in which we live
Role of the OTARole of the OTA Assist NCEH/ATSDR with requests from Assist NCEH/ATSDR with requests from
tribes for consultation/public health tribes for consultation/public health assessmentsassessments
Works with external entities to fill data gaps Works with external entities to fill data gaps within tribal communitieswithin tribal communities Internal collaboration in solving health issuesInternal collaboration in solving health issues
Builds bridges between environmental Builds bridges between environmental health and environmental protection in health and environmental protection in Indian CountryIndian Country Main point of contactMain point of contact
Historic OTA Projects Historic OTA Projects (2004)(2004) Hopi Reservation pesticides Hopi Reservation pesticides
health assessmenthealth assessment Tohono o’ Odham emergency Tohono o’ Odham emergency
response capabilitiesresponse capabilities Squaxin Island Tribes of Puget Squaxin Island Tribes of Puget
fish consumption surveyfish consumption survey Port Graham Village council Port Graham Village council
research protocolresearch protocol Tar Creek superfund site work Tar Creek superfund site work
on leadon lead Alaska FUDsAlaska FUDs Navajo Nation Youth Risk Navajo Nation Youth Risk
Behavior SurveyBehavior Survey Salish/ Kootenai decrease in Salish/ Kootenai decrease in
Methamphetamine Methamphetamine laboratorieslaboratories
College of Menominee Nation College of Menominee Nation building environmental public building environmental public health capacityhealth capacity
Navajo Nation dip vats Public Navajo Nation dip vats Public Health consultationHealth consultation
Confederate tribes of Colville Confederate tribes of Colville public health assessment/ public health assessment/ petition procedurepetition procedure
St. Regis Mohawk tribe PCB St. Regis Mohawk tribe PCB researchresearch
Mold and moisture conditions Mold and moisture conditions in Native American housingin Native American housing
Environmental health plan Environmental health plan proposal tribes impacted by proposal tribes impacted by Hanford Nuclear reservationHanford Nuclear reservation
Current OTA Projects – Current OTA Projects – Summer 2008Summer 2008
Lummi Nation Specific Fish Consumption Lummi Nation Specific Fish Consumption SurveySurvey
Sisseton Sioux Nation concerns on Mold Issues Sisseton Sioux Nation concerns on Mold Issues Yurok nation of California wildfiresYurok nation of California wildfires Strategic development of current and future Strategic development of current and future
activitiesactivities
** Health and environmental impacts of Uranium Health and environmental impacts of Uranium contamination in the Navajo Nationcontamination in the Navajo Nation
** Native American Environmental Health Native American Environmental Health Research InitiativeResearch Initiative
Project 1: Navajo Uranium Project 1: Navajo Uranium MiningMining
In 1944-1986 4M tons of In 1944-1986 4M tons of Uranium extracted in the Navajo Uranium extracted in the Navajo Nation. Nation.
Left the Navajo with a legacy of Left the Navajo with a legacy of Over 500 abandoned uranium Over 500 abandoned uranium
mines (AUM’s), mines (AUM’s), 4 inactive uranium milling 4 inactive uranium milling
sites, sites, 1 former dump site, 1 former dump site, Contaminated ground water, Contaminated ground water, Structures that contain Structures that contain
elevated levels of radiationelevated levels of radiation March 2008 - 5 year plan as March 2008 - 5 year plan as
requested by House Committee requested by House Committee on oversight and government on oversight and government reformreform
House committee asked House committee asked BIA, DOE, NRC, EPA and BIA, DOE, NRC, EPA and IHS to develop a IHS to develop a coordinated plan to coordinated plan to address:address: Assessment of Assessment of
contaminated water contaminated water sourcessources
Cleanup of contaminated Cleanup of contaminated sitessites
Alternate water supplies Alternate water supplies Assessment of AUM’sAssessment of AUM’s Case controlled studies Case controlled studies
of health risksof health risks
Role of NCEH/ ATSDRRole of NCEH/ ATSDRWaxman committee requested brief on:Waxman committee requested brief on:
Endeavors related to uranium contamination Endeavors related to uranium contamination of water supplies on Navajo land including:of water supplies on Navajo land including:
Projects NCEH/ ATSDR have done to dateProjects NCEH/ ATSDR have done to date Plans for future workPlans for future work
MOU’S with BIA where activities and MOU’S with BIA where activities and funding can be executedfunding can be executed
Other ways the agencies can contribute to Other ways the agencies can contribute to the futurethe future
Staff expertise (assessment/evaluation Staff expertise (assessment/evaluation of contamination)of contamination)
Project 2: Native American Project 2: Native American Environmental Health Research Environmental Health Research
InitiativeInitiative Yu’pik Eskimo/ AthabascansYu’pik Eskimo/ Athabascans High exposure to POPsHigh exposure to POPs Elevated incidence of chronic disease Elevated incidence of chronic disease
Diabetes, Colon cancerDiabetes, Colon cancer Coordinate analytical studies for POP Coordinate analytical studies for POP
evaluationevaluation University/ State partners (leverage University/ State partners (leverage
resources to greatest extent)resources to greatest extent)
Establish contacts within the Alaska Establish contacts within the Alaska Native American villages that are Native American villages that are susceptible to health disparities susceptible to health disparities Chemical exposure through hunting and Chemical exposure through hunting and
fishing subsistence. fishing subsistence. Exchange information with Tribal Exchange information with Tribal
environmental workgroupsenvironmental workgroups Make site-specific visits in order to Make site-specific visits in order to
review the policy and procedure that review the policy and procedure that is necessary for investigationis necessary for investigation
Role of OTARole of OTA
Project 3: Ambient air Project 3: Ambient air pollution in Children with pollution in Children with
sickle cellsickle cell NCEH Air Pollution and Respiratory NCEH Air Pollution and Respiratory
Health branchHealth branch Ambient air pollution associated with Ambient air pollution associated with
increase risk of respiratory increase risk of respiratory complicationscomplications
Goal: Determine if ambient Goal: Determine if ambient concentration of air pollutants in concentration of air pollutants in Atlanta, GA are associated with adverse Atlanta, GA are associated with adverse health effects in children with SCDhealth effects in children with SCD
Role of the InternRole of the Intern Create survey database Create survey database
data entry design and structure data entry design and structure managementmanagement
Field equipment training session Field equipment training session attendanceattendance gain knowledge of state of the art gain knowledge of state of the art
monitoring instrumentation monitoring instrumentation accurate collection of respiratory health accurate collection of respiratory health
measurements. measurements. Explore the collaboration of OTA and Explore the collaboration of OTA and
other ATSDR branchesother ATSDR branches Air Pollution and Respiratory Health Air Pollution and Respiratory Health
Training Session
Future OTA ProjectsFuture OTA Projects Bridge the gap between Environmental Bridge the gap between Environmental
concerns and environmental healthconcerns and environmental health Training programs for working in Indian Training programs for working in Indian
CountryCountry Continued education around traditional Continued education around traditional
ways of life through a Native perspectiveways of life through a Native perspective Develop tribal-specific health modelsDevelop tribal-specific health models Support in interpreting/ sharing dataSupport in interpreting/ sharing data Increase Staff/ BudgetIncrease Staff/ Budget
Recommendations for Recommendations for the futurethe future
Locations in addition to AtlantaLocations in addition to Atlanta Survey tribal public health needs on Survey tribal public health needs on
a national scalea national scale Strengthen alliancesStrengthen alliances
Advocate for funding and programsAdvocate for funding and programs Tribal College/ University outreachTribal College/ University outreach Conduct evaluations of OTAConduct evaluations of OTA
Take home lessons - OTATake home lessons - OTA Essential role – Tribal environmental/ Health Essential role – Tribal environmental/ Health
issuesissues Speaks for both partiesSpeaks for both parties
Trust between agencies and tribeTrust between agencies and tribe People who are enthusiastic and People who are enthusiastic and
understanding about cultureunderstanding about culture Recognize significance of Native American Recognize significance of Native American
perspective and input on environmental issuesperspective and input on environmental issues Career opportunities/ serving the communityCareer opportunities/ serving the community
Thank you!Thank you!
ReferencesReferences Agency for health care Policy and Research. Sickle cell disease. Screening, Agency for health care Policy and Research. Sickle cell disease. Screening,
diagnosis, management and in new born and infants. Clinical Practice Guideline. diagnosis, management and in new born and infants. Clinical Practice Guideline. Rockville, MD: Agency for health care Policy an Research, 1993. Publication 93-Rockville, MD: Agency for health care Policy an Research, 1993. Publication 93-0562 0562
Report on the expert panel to evaluate ATSDR’s Office of Tribal Affairs. Prepared 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. by the Agency for Toxic Substance and Disease Registry. ERG Lexington, MA. 20072007
http://www.atsdr.cdc.gov/HAC/PHAmanual/ch2.htmlhttp://www.atsdr.cdc.gov/HAC/PHAmanual/ch2.html
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