protecting people through tribal public health codes: legal technical assistance and resources for ...
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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 - PowerPoint PPT PresentationTRANSCRIPT
FRAMING THE DISCUSSION M AY 1 6 , 2 0 1 4
Protecting People through Tribal Public Health Codes: Legal Technical Assistance and Resources
for Tribes and Tribal Serving Organizations
Jennifer Giroux, MD, MPHMedical Epidemiologist
Great Plains Area Indian Health ServiceGreat Plains Tribal Chairmen’s Health BoardNorthern 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
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American Public Health System
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Surveillance of Infectious Diseases Among American Indians/ AK Natives Bertolli et al,
2008
Case reported to state/county agencies
IHS (%)n=45/68
2001
Tribal / Urban (%)n = 66/120
2004HIV/AIDS 96 67
STDs 98 71
Hepatitis A 93 62
Hepatitis B 93 65
Hepatitis C 91 67
Tuberculosis 96 71
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Surveillance of Infectious Diseases Among American Indians/ AK Natives Bertolli et al,
2008
Received state/ county surveillance report
IHS (%)n=45/68
2001
Tribal / Urban (%)n = 66/120
2004HIV/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
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Multistate Assessment of Public Surveillance Relevant to AI/ AN, 2007, Bertolli et al 2011
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
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Public Health
“ 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 andindividuals."
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 HealthModel
Medical Model
Versus
1. Monitor health status2. Diagnose and investigate3. Inform and educate4. Mobilize communities to identify problems5. Develop policies and plans6. Enforce laws and regulations7. Link people to needed health services8. Assure a competent healthcare workforce9. Evaluate health services10. Conduct research
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Public Health Ten Essential Services
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Need for Integration of Tribal Nations into American Public Health System,
Reportable Disease Surveillance System
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
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Need for Integration of Tribal Nations into American Public Health System,
Reportable Disease Surveillance System
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 functionwithin the reportable disease surveillance process.
Tribes have no involvement in submission of reportable disease data where IHS provides direct services
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Need for Integration of Tribal Nations into American Public Health System, Reportable Disease Surveillance System
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 from the Centers for Disease Control and Prevention Public Health Law Program through a sub-award from the Association
of State and Territorial Health Officials