Tribal Public Health Law

Tribes across the country have made impressive strides in many areas of health care. More often than not, Tribes have done this work with small staffs and small budgets. Dedication to the task and determination to see it through have resulted in improved care in some significant areas, including the treatment and management of diabetes. This progress brings the promise of better health for the next generation of Indian Country.

While these strides give real hope, they must be coupled with energetic efforts to address public health. Many of the health disparities that continue to exist in Indian Country can be most effectively addressed by public health initiatives.

As many readers know, a number of public health issues either closely approach or reach epidemic status in American Indian/Alaska Native 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 American Indian or Alaska Native communities.⁴
• A 2005 survey found that American Indians/Alaska Natives 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 Approach as a Strategy to Address these Disparities

These statistics give an idea of the problems, but we must remember that behind each statistic is a story of an individual, a family or a community. These statistics represent suffering that, in large part, can be avoided. Public health initiatives provide the best means to systematically address and prevent these adverse health outcomes.

Public Health Initiatives

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.

Public Health Law

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 law 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 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 surmounting these barriers.

NIHB is honored to be part of this project – one that has the potential to positively impact so many American Indian and Alaska Native people – particularly children. This project will provide the tools Tribes want and need, to utilize public health law to keep their communities healthy and safe.

To get involved in this project, please contact Robert Foley, Acting Director of Public Health Programs and Policy at 202-355-5494 or [email protected], Malia Villegas, Director, NCAI Policy Research Center at [email protected].

• ¹Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-Based Injury Statistics Query and Reporting System (WISQARS)(online)(2009).
• ²Bernard SJ, Paulozzi LJ, Wallace LJD. Fatal Injuries Among Children by Race and Ethnicity – United States, 1999-2002. MMWR 2007:56(No. SS-5).
• ³Centers for Disease Control and Prevention. Cigarette smoking among adults—United States, 2006. MMWR. 2007; 56(44):1157–1161.
• ⁴The Great Lakes Intertribal Council, Inc. (GLITC). Great lakes intertribal council youth tobacco survey 2000: prevalence of tobacco use. Lac du Flambeau, WI: Great Lakes EpiCenter; 2000.
• ⁵Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Methamphetamine Use, Abuse, and Dependence: 2002, 2003, and 2004. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2005.
• ⁶Indian Health Service, Office of Public Health Support, Division of Program Statistics. Trends in Indian Health, 2002-2003 Ed. Rockville, MD: Indian Health Service; 2003.
• ⁷Alaska Native Tribal Health Consortium Injury Prevention Program and the Alaska Native Epidemiology Center. Alaska Native Injury Atlas of Mortality and Morbidity. Anchorage, AK: Alaska Native Tribal Health Consortium; 2008.