Public Health Law

Tribal Public Health Law

Tribes across the country made impressive strides in many areas of healthcare with minimal capacity and small budgets. Their dedication and determination resulted in improved care in significant areas, including the treatment and management of diabetes. This progress brings the promise of better health for the next generation of Indian Country.

Public Health Challenges in AI/AN Communities

While these strides give real hope, they must be coupled with energetic efforts to address public health. Several public health issues either closely approach or reach epidemic status in American Indian and Alaska Native (AI/AN) communities. Consider the following recent statistics:

  • The CDC reported that adult motor vehicle-related death rates for AI/AN are more than twice that of white adults and almost twice that of black adults.1
  • Among infants less than one year of age, AI/AN have consistently higher total injury death rates than other racial/ethnic populations and the highest rate of motor-vehicle traffic deaths.2
  • The national surveillance data that are available suggest that American Indians and Alaska Natives have the highest commercial tobacco use prevalence among the major U.S. racial and ethnic groups, which include African Americans, Hispanics, Asians, American Indians or Alaska Natives, and whites (35.6%).3
  • Furthermore, data from the few Tribe-specific commercial tobacco surveys that have been conducted suggest that commercial tobacco use could be as high as 63% in some AI/AN communities.4
  • A 2005 survey found that AI/AN had higher methamphetamine use rates (for the year prior) than any other racial group surveyed except Native Hawaiians/Pacific Islanders.5
  • The Indian Health Service issued a report finding that the suicide rate for American Indians/Alaska Natives in the IHS service areas (for 2002-2004) was 1.7 times that of the U.S. all-races rate (for 2003).6
  • For some Native communities, the overall rates for suicide (all age categories, not only youth) were 3.5 times that of the overall U.S. population suicide rate.7

Public Health Initiatives and Law

Public health initiatives encompass a wide range of activities, from health promotion to disease and injury prevention to emergency preparation. Public health initiatives also range in the types of strategies they employ. An initiative may use a broad education campaign, or a targeted intervention, or an attractive incentive to bring about improvements in public health. Sometimes initiatives focus on learning more about a problem or developing better surveillance of disease. At other times, a public health initiative utilizes law and policy to bring about better health for a community.

Not every public health problem can or should be addressed through law. Some problems may be better suited to education efforts, for instance. But some of the most critical public health problems in Indian Country – like the epidemic of accidental injury – may be most effectively addressed by law, often in combination other public health strategies.

From second-hand smoking laws to seat belt laws to traffic codes – we see positive and dramatic results from Tribes, across the country, enacting these types of laws. Of course, not every Tribe has these types of laws in place, nor does every Tribe have the resources to make this legal structure a reality.

Tribal Public Health Law Project

The National Indian Health Board (NIHB) has partnered with the National Congress of American Indians (NCAI) to assist Tribes who would like to learn more about or enact public health laws. As part of this project, NIHB and NCAI will work to raise awareness of public health laws (and their potential positive impacts) and identify and showcase existing Tribal public health laws. We will also discuss existing barriers to utilizing public health law as public health approach and invite stakeholders to join the discussion to generate strategies to overcome these barriers.

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March 4, 2025 - March 5, 2025

National Indian Health Board will host the Tribal Health Data Symposium on March 4–5, 2025

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NIHB Response to Executive Orders

President Trump’s recent Executive Orders on federal funding could have serious implications for Tribal health. NIHB is actively advocating for Tribal Nations and providing key updates—click to learn more and access resources.